## Facts

- The Secretary of Health and Human Services administered Medicare Part B, a voluntary, federally subsidized insurance program covering physician services.
- A Medicare Part B regulation authorized paying different benefit amounts for similar physician services based on physician specialty.
- A physician association and individual participating physicians filed suit in federal court challenging the regulation as contrary to the Medicare statute.
- The District Court held the regulation invalid on statutory grounds and rejected the Secretary’s claim that Congress barred judicial review of all Part B questions affecting benefit amounts.
- The Sixth Circuit affirmed.
- The Secretary sought Supreme Court review solely on jurisdiction, not on the merits of the regulation’s invalidation.

## Issues

1. Whether 42 U.S.C. § 1395ff or 42 U.S.C. § 1395ii bars federal-court review of challenges to the validity of Medicare Part B regulations affecting benefit amounts.
2. Whether statutory limits on review of individual Part B “amount determinations” also preclude review of the legality of the methodology and regulations used to set those amounts.

## Decision

- The Court unanimously affirmed.
- Congress did not bar judicial review of regulations promulgated under Medicare Part B in either § 1395ff or § 1395ii.
- Federal courts have jurisdiction to hear substantial statutory and constitutional challenges to Part B regulations, including challenges to the method by which benefit amounts are determined.
- Limits on review of individual Part B amount determinations do not foreclose review of broader attacks on the validity of governing regulations.

## Legal Principles

- There is a strong presumption favoring judicial review of administrative action; a bar on review requires clear and convincing evidence of congressional intent.
- Medicare’s detailed provisions governing review of benefit “amount determinations” address individual payment decisions and do not, by silence, foreclose challenges to the legality of the regulatory methodology used to calculate benefits.
- Prior precedent precluding judicial review of individual Part B amount determinations does not control challenges to the validity of Part B regulations establishing the payment methodology.
- Incorporation of 42 U.S.C. § 405(h) through 42 U.S.C. § 1395ii is construed in light of Medicare’s structure and history and precludes review of discrete Part B amount determinations, not substantial statutory or constitutional challenges to Part B administration.
- Reading the statute to deny any judicial forum for constitutional claims would raise serious constitutional concerns, supporting a construction allowing review absent a clear bar.

## Conclusion

The Court held that the Medicare Act does not clearly preclude judicial review of statutory or constitutional challenges to Medicare Part B regulations governing how benefits are calculated, even though Congress limited review of individual Part B payment amount determinations; the lower courts therefore had jurisdiction to invalidate the challenged regulation.


Bowen v. Mich. Acad. of Fam. Physicians, 476 U.S. 667 (1986)