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If the Medicare Appeals Council (MAC) issues an adverse decision, or the MAC denied the enrollee's request to review an Administrative Law Judge's decision, the enrollee may request a review by a Federal District Court. An enrollee or an enrollee's appointed representative may request a review by a Federal District Court. An enrollee's prescribing physician may not request a Federal District Court review on an enrollee's behalf unless the enrollee's physician is also the enrollee's appointed representative. For more information about appointing a representative, see section 10.4 in Chapter 18 of the Prescription Drug Benefit Manual. You may view Chapter 18 of the Prescription Drug Benefit Manual by clicking on the link in the "Downloads" section below. How to Request a Review by a Federal District Court In order to request a review by a Federal District Court, the amount remaining in controversy must be at least $1180. This amount may change each year. For more information about how the amount remaining in controversy is computed, see section 110 in Chapter 18 of the Prescription Drug Benefit Manual. You may view Chapter 18 of the Prescription Drug Benefit Manual by clicking on the link in the "Downloads" section below. The request must be filed with the proper Federal District Court within 60 calendar days from the date of the notice of the MAC's decision. All requests must be made in writing. If the MAC's decision is unfavorable, the decision will contain the information an enrollee needs to file a request for review by a Federal District Court. For a description of the procedures an appellant must follow in requesting judicial review, see Title 42, Part 423, section 630, and Title 20, Part 422, section 210 of the Code of Federal Regulations (CFR). Click on the links in the "Related Links Outside CMS" section below.
Page Last Modified: 05/27/2008 10:10:19 AM
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