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42 U.S.C. § 1320c–4

Right to hearing and judicial review

United States · Title 42 — THE PUBLIC HEALTH AND WELFARE · Status: effective

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42 U.S.C. § 1320c–4, Right to hearing and judicial review, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/477146
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Any beneficiary who is entitled to benefits under subchapter XVIII, and, subject to section 1320c–3(a)(3)(D) of this title, any practitioner or provider, who is dissatisfied with a determination made by a contracting quality improvement organization in conducting its review responsibilities under this part, shall be entitled to a reconsideration of such determination by the reviewing organization. Where the reconsideration is adverse to the beneficiary and where the matter in controversy is $200 or more, such beneficiary shall be entitled to a hearing by the Secretary (to the same extent as beneficiaries under subchapter II are entitled to a hearing by the Commissioner of Social Security under section 405(b) of this title). For purposes of the preceding sentence, subsection (l) of section 405 of this title shall apply, except that any reference in such subsection to the Commissioner of Social Security or the Social Security Administration shall be deemed a reference to the Secretary or the Department of Health and Human Services, respectively. Where the amount in controversy is $2,000 or more, such beneficiary shall be entitled to judicial review of any final decision relating to a reconsideration described in this subsection.

Legislative history

The public laws that enacted or amended this section. Tallies are for the whole bill as it passed each chamber — often an omnibus covering far more than this provision — not a vote on this section alone.

  • Enacted byPub. L. 97-248(H.R. 4961)1982-09-03
    Tax Equity and Fiscal Responsibility Act of 1982
    House: no recorded tallySenate: no recorded tally
  • Amended byPub. L. 101-239(H.R. 3299)1989-12-19
    Omnibus Budget Reconciliation Act of 1989
    House: no recorded tallySenate: 87–7
  • Amended byPub. L. 103-296(H.R. 4277)1994-08-15
    Social Security Independence and Program Improvements Act of 1994
    House: 431–0Senate: no recorded tally
  • Amended byPub. L. 112-40(H.R. 2832)2011-10-21
    To extend the Generalized System of Preferences, and for other purposes.