Dist. Ct. did not err in dismissing for lack of jurisdiction lawsuit filed by plaintiff (state-created insolvency insurer for member insurance companies) seeking determination that it was not subject to reporting requirements under section 111 of Medicare, Medicaid, and SCHIP Extension Act. Plaintiff asserted that it, as entity that has acquired insolvent primary insurers, had no obligation to make reports about Medicare plan participants and claimants to assist government in identifying when primary health care providers are responsible for repaying medical expenses that Medicare covered conditionally, where its primary insurers had become insolvent. Dist. Ct. lacked jurisdiction under 42 USC section 405(h) to consider plaintiff’s lawsuit, because plaintiff had failed to obtain ruling on its claim through four-step administrative process set forth in 42 USC 405(g) prior to filing instant lawsuit. Ct. rejected plaintiff’s claim that filing of instant lawsuit was proper, where it had no avenue for seeking ruling on its claim through instant administrative process.
Federal 7th Circuit Court
Civil Court
Medicare