Maximum Comfort Inc. v. Secretary of Health

I. BACKGROUND: PART B OF THE MEDICARE ACT

The Medicare Act, established under Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395-1395hhh, provides coverage for certain medical services to eligible aged and dis- abled people. The Medicare Program is administered by the Centers for Medicare and Medicaid Services, on behalf of the Department of Health and Human Services. Part B of the Medicare Act provides supplementary medical insurance for, inter alia, covered medical supplies, including durable medi- cal equipment such as power-operated wheelchairs. 42 U.S.C. §§ 1395j–1395w-4.

In administering Part B, the Centers act through private entities, such as insurance companies, called “carriers.”2 Claims for durable medical equipment are processed by desig- nated regional carriers. See 42 U.S.C. §§ 1395m(a)(12), 1395u. Upon receipt of a claim for such equipment, the carrier pays the Medicare beneficiary on the basis of an itemized bill, or pays the Medicare supplier on the basis of an assignment of benefits from the beneficiary. 42 U.S.C. § 1395u(b)(3)(B).

In order for the beneficiary, and therefore the equipment supplier, to be reimbursed for a claim, Medicare requires…