## Facts

- Raymond H. Giesse, a Medicare+Choice enrollee in a Kaiser plan, suffered a stroke and received rehabilitation services, including placement in a skilled nursing facility (SNF).
- Kaiser notified Giesse that his Medicare SNF benefits would be terminated and advised him of a right to an expedited administrative appeal.
- Giesse did not pursue an expedited appeal at the time of the termination notice.
- He left the SNF, later sold his home, and used the proceeds to pay for continuing care.
- Roughly two months later, he asked Kaiser to “reconsider” the termination, seeking monetary damages (including consequential harms) rather than reinstatement of SNF coverage.
- Kaiser treated the request as a grievance and denied it; the independent review entity dismissed it as a damages grievance rather than a coverage appeal.
- An Administrative Law Judge dismissed for lack of jurisdiction because the request did not present a Medicare “determination” on covered services; the Medicare Appeals Council affirmed.
- Giesse sued in federal district court asserting due process claims, a Bivens claim, and state-law tort claims; the district court dismissed for lack of subject-matter jurisdiction, and Giesse appealed.

## Issues

1. Whether Giesse’s constitutional and related damages claims “arose under” the Medicare Act and therefore had to be channeled through the Act’s administrative review process before judicial review.
2. Whether any exception permitted immediate federal-court jurisdiction because the constitutional claim was “wholly collateral” to a benefits dispute or because channeling would effectively deny review.
3. Whether a Bivens damages remedy is available for alleged constitutional violations connected to Medicare benefit determinations.

## Decision

- The Sixth Circuit affirmed dismissal for lack of subject-matter jurisdiction.
- Giesse’s constitutional and damages claims arose under the Medicare Act because they were inextricably intertwined with the termination of Medicare SNF benefits.
- The “wholly collateral”/no-review exception did not apply because the asserted injury depended on the benefits termination and the statutory process offered a route to review if timely pursued.
- No Bivens remedy was available; the Medicare and Social Security remedial schemes displaced an implied constitutional damages action in this context.

## Legal Principles

- Claims “arise under” the Medicare Act when the Act supplies the standing and substantive basis for the claim, or when the claim is inextricably intertwined with a benefits determination.
- When a claim arises under the Medicare Act, federal-question jurisdiction is generally barred until the claimant obtains a final agency decision through the prescribed administrative process (as incorporated via the Social Security Act’s review provisions).
- A constitutional label or request for consequential damages does not avoid channeling if the claim’s substance is a challenge to a benefits termination or denial.
- The “wholly collateral” exception is narrow and does not apply where the constitutional claim turns on the correctness of the benefits determination and administrative review was available.
- Courts will not extend Bivens where Congress has provided a comprehensive, detailed remedial framework for disputes of the type presented.

## Conclusion

The court held that a beneficiary’s damages-based constitutional attack on a Medicare SNF benefits termination must proceed through the Medicare administrative review scheme, and that the statutory remedial structure also forecloses a Bivens damages remedy arising from benefit determinations.


Giesse v. Sec'y of Dep't of Health & Hum. Servs., 522 F.3d 697 (6th Cir. 2008)