Bowen v. Michigan Academy of Family Physicians

PETITIONER: Bowen
RESPONDENT: Michigan Academy of Family Physicians
LOCATION: Maine State Legislature

DOCKET NO.: 85-225
DECIDED BY: Burger Court (1981-1986)
LOWER COURT: United States Court of Appeals for the Sixth Circuit

CITATION: 476 US 667 (1986)
ARGUED: Jan 22, 1986
DECIDED: Jun 09, 1986

ADVOCATES:
Alan G. Gilchrist - on behalf of the Respondents
Edwin S. Kneedler - on behalf of the Petitioners

Facts of the case

Question

Media for Bowen v. Michigan Academy of Family Physicians

Audio Transcription for Oral Argument - January 22, 1986 in Bowen v. Michigan Academy of Family Physicians

Warren E. Burger:

Mr. Kneedler, I think you may proceed whenever you are ready.

Edwin S. Kneedler:

Thank you, Mr. Chief Justice, and may it please the Court:

The question presented in this case is whether respondents have a right to judicial review of matters concerning the amount of benefits under Part B of the Medicare program.

Part B establishes a voluntary program of supplementary medical insurance that pays in general 80 percent of the reasonable charge of physician services and other services.

Part A of the program, which establishes the basic hospital insurance program, is not directly involved in this case.

The principal relevance of Part A here, however, is that under Part A Congress has expressly provided for judicial review of benefit determinations where the amount in controversy exceeds $1,000, and this demonstrates that where Congress intends to provide for judicial review under the Medicaid program, it expressly does so.

Under Part B, however, Congress has not affirmatively authorized judicial review.

Four terms ago, in United States versus Erika, this Court unanimously held that by this omission Congress had deliberately foreclosed judicial review.

The Court there relied on what Congress perceived to be the relatively insubstantial amount of money involved in the typical Part B claim.

The Court adhered to this view of reviewability under Part B just two terms ago in Heckler versus Ringer.

Although Congress has extensively revised the Part B program in a number of respects since Erika was decided, it has not enacted legislation to overrule that decision.

Bills have been introduced to accomplish that result, however, and as we point out in our reply brief the committee reports on those bills demonstrate Congress's understanding that under existing law judicial review is entirely foreclosed under Part B.

In these circumstances we believe it would be especially prudent for the Court to adhere to its rulings in Erika and Ringer and leave to Congress, which is studying the matter, the question of whether exceptions should be carved out to that preclusion.

Sandra Day O'Connor:

Mr. Kneedler, do you think that constitutional challenges to the application of the Secretary's guidelines concerning Part B can be challenged in court?

Edwin S. Kneedler:

Well, as we pointed out in our brief, of course we think that issue is not presented here because the particular--

Sandra Day O'Connor:

Well, they've certainly made a constitutional claim.

Edwin S. Kneedler:

--They have made a constitutional claim, but it is our submission, for the reasons we have stated in the brief, that it is so insubstantial as not to vest the Court with subject matter jurisdiction under the rationale that the Court disposed of the constitutional claim in Ringer itself.

We think that's so because the regulation that's being challenged simply authorizes the establishment of separate charge screens, or prevailing charge screens, based on the charging patterns that exist in the community, and where a carrier implements that principle and adopts separate prevailing charge screens that are simply based on the charging patterns in the community, we think that that can in no way be thought to be so utterly lacking in rational justification under Flemming versus Nestor as to--

Sandra Day O'Connor:

Well, it did... it did appear to me, anyway, that the plaintiffs below made three different kinds of challenges.

One was to the carrier's utilization and application of the Secretary's rules on Part B, and second was a challenge to the Secretary's regulations themselves, and an allegation that the Secretary's regulations did not meet the statutory requirements that Congress had laid down, and third, a constitutional challenge.

Now, do you think that Erika precludes the constitutional challenge?

I guess you think not, but you think it's insubstantial?

Edwin S. Kneedler:

--Well, yes.

Erika, we think, didn't address it because there was not a constitutional question raised.

Sandra Day O'Connor:

What about an allegation, that the regulations of the Secretary simply don't conform to the statute?

Edwin S. Kneedler:

On that question, we think the judicial review is plainly foreclosed.

In Erika... Erika itself involved a challenge to instructions from the Secretary that is, insofar as the carrier is concerned, there is binding regulations, and the Court--

Sandra Day O'Connor:

The language in Erika doesn't make too clear that that was intended.

Edwin S. Kneedler:

--But the Court of Claims decision in Erika, however, at pages 590 to 591 of 634 F. 2d do discuss the carrier's challenge to the intermediary letter upon which the carrier relied and also several additional letters implementing that, and the Court of Claims did review the carrier's... the question of the carrier's reliance on those letters and held that they were not a valid basis for the carrier to deny claims.

Sandra Day O'Connor:

Well, why would a challenge to the regulation as not meeting the statutory requirement be a burden to the Court such as review of the typical Part B benefit claim?