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Hays v. Sebelius, No. 08-5508

In an action by a Medicare Part B beneficiary challenging a decision by a regional Medicare contractor to reimburse for a particular drug only up to the price of its least costly alternative, summary judgment for plaintiff is affirmed where the Medicare Act unambiguously foreclosed that determination and required instead that Medicare pay for covered items or services at a statutorily prescribed rate.

Read Hays v. Sebelius, No. 08-5508

Appellate Information

Argued November 5, 2009

Decided December 22, 2009


Opinion by Judge Tatel


For Appellants:

Samantha L. Chaifetz, Mark B. Stern and Christopher C. Fonzone, U.S. Department of Justice, Washington, DC

For Appellee:

Stuart M. Gerson and Robert E. Wanerman, Epstein Becker & Green LLP, Washington, DC