Bowen v. Academy of Family Physicians, 476 U.S. 667 (1986)

Bowen v. Michigan Academy of Family Physicians

No. 85-225

Argued January 22, 1986
Decided June 9, 1986
476 U.S. 667

CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR

THE SIXTH CIRCUIT

Syllabus

Respondents, who include an association of family physicians and several individual doctors, filed suit in Federal District Court to challenge the validity of a regulation that was promulgated under Part B of the Medicare program and that authorizes the payment of benefits in different amounts for similar physicians’ services. Holding that the regulation contravened several statutory provisions governing the Medicare program, the court rejected the Secretary of Health and Human Services’ contention (the question presented in this Court) that Congress has forbidden judicial review of all questions affecting the amount of benefits payable under Part B of the Medicare program. The Court of Appeals agreed.

Held: In neither 42 U.S.C. § 1395ff (1982 ed. and Supp. II) nor § 1395ii (1982 ed., Supp. II), has Congress barred judicial review of regulations promulgated under Part B of the Medicare program. Pp. 670-682.

(a) There is a strong presumption that Congress intends judicial review of administrative action. Only upon a showing of clear and convincing evidence of a contrary legislative intent should the courts restrict access to judicial review. Pp. 670-673.

(b) The provisions of § 1395ff(b) that authorize administrative and judicial review of determinations as to the amount of benefits under Part A of the Medicare program do not impliedly foreclose judicial review of Part B regulations. The reticulated statutory scheme, which details the forum and limits of review of determinations of the amounts of benefits payable under Parts A and B, simply does not speak to challenges as to the method by which such amounts are to be determined, rather than the determinations themselves. That Congress did not preclude review of the method by which Part B awards are computed (as opposed to the computation) is supported by the legislative history. United States v. Erika, Inc., 456 U.S. 201, explained. Pp. 674-678.

(c) Nor does § 1395ii, which states that 42 U.S.C. § 405(h) (1982 ed., Supp. II), along with other provisions of the Social Security Act, shall be applicable to the Medicare program, preclude judicial review here. Regardless of the abstract meaning of § 405(h), which prohibits certain actions against the Government or its officers, that section does not apply on its own terms to Part B, but is instead incorporated mutatis mutandis by § 1395ii. The legislative history of the Medicare program provides specific evidence of Congress’ intent to foreclose review only of "amount determinations," not of substantial statutory and constitutional challenges to the Secretary’s administration of Part B. Pp. 678-681.

757 F.2d 91, affirmed.

STEVENS, J., delivered the opinion of the Court, in which all other Members joined except REHNQUIST, J., who took no part in the consideration or decision of the case.