TERRENCE G. BERG, District Judge.
Plaintiff Gina Moller, who is representing herself, seeks to challenge Medicare's payment structure as it relates to mental health services. Plaintiff's Complaint asserts that The Centers for Medicare & Medicaid Services ("CMS") is unlawfully discriminating against those with mental health disorders, in violation of the equal protection clause of the Fourteenth Amendment to the Constitution of the United States, by requiring them to pay a greater percentage of the cost of mental-health services than what is required for non-mental-health services.
Before the Court is Defendant's Motion to Dismiss for lack of subject matter jurisdiction (Dkt. 14), arguing both that Plaintiff has failed to exhaust administrative remedies prior to filing suit, and that the amount in controversy is less than the amount necessary to entitle Plaintiff to judicial review. Pursuant to Eastern District of Michigan Local Rule 7.1(f)(2) this
As further discussed below, the Court finds that because Plaintiff did not pursue the administrative remedies set forth in the Medicare Act before filing this lawsuit, the Court does not have jurisdiction. For that reason, Defendant's motion is GRANTED and the case is DISMISSED WITHOUT PREJUDICE.
Federal courts are courts of limited jurisdiction. In other words, unless jurisdiction is authorized by the Constitution or other federal laws, district courts lack the power to adjudicate legal disputes. "It is to be presumed that a cause lies outside this limited jurisdiction, and the burden of establishing the contrary rests upon the party asserting jurisdiction." Kokkonen v. Guardian Life Ins. Co. of Am., 511 U.S. 375, 377, 114 S.Ct. 1673, 128 L.Ed.2d 391 (1994) (citations omitted).
Under 28 U.S.C. § 1331, federal district courts "have original jurisdiction of all civil actions arising under the Constitution, laws, or treaties of the United States." The jurisdiction conferred on federal courts by this statute is commonly referred to as "federal question" jurisdiction, and it typically allows this Court to hear cases where a plaintiff alleges that a certain federal law violates the Constitution. However, this is a case challenging the allocation of costs under Medicare, and Congress has prescribed a specific and exclusive method for judicial review of any and all disputes arising under the Medicare program. See Michigan Ass'n of Homes and Services For Aging v. Shalala, 127 F.3d 496, 497 (6th Cir.1997); Michigan Ass'n of Indep. Clinical Labs. v. Shalala, 52 F.3d 1340, 1344-46 (6th Cir.1994).
In particular, Congress has limited federal court jurisdiction by expressly incorporating 42 U.S.C. § 405(h) of the Social Security Act into the Medicare Act. See 42 U.S.C. § 1395ii. Section 405(h) provides:
42 U.S.C. § 405(h). Furthermore, according to Sixth Circuit Court of Appeals and Supreme Court precedent, § 405(h) even bars the exercise of federal question jurisdiction in cases such as this, where a plaintiff's challenge is based on the Constitution. See Michigan Ass'n of Homes and Services For Aging, 127 F.3d at 499; see also Weinberger v. Salfi, 422 U.S. 749, 766-67, 95 S.Ct. 2457, 45 L.Ed.2d 522 (1975) (finding that the Secretary may waive administrative hearing requirement where sole question is a matter of Constitutional law, but noting that the Secretary must first be given an opportunity to respond to claim); Heckler v. Ringer, 466 U.S. 602, 622, 104 S.Ct. 2013, 80 L.Ed.2d 622 (1984) (finding that jurisdictional bar applies to constitutional challenges, unless such challenges are "wholly collateral" to a claim for benefits); Shalala v. Illinois Council on Long Term Care, Inc., 529 U.S. 1, 10, 120 S.Ct. 1084, 146 L.Ed.2d 1 (2000) (noting that where a plaintiff seeks a monetary benefit, the "statute plainly bars
According to these cases and the relevant federal statutes, the
The Medicare Act not only provides the sole basis for jurisdiction over Medicare claims, but it also requires that claims be pursued all the way to the end of an administrative review process before the Court is able to exercise its jurisdiction. See 42 U.S.C. § 1395ff(b)(1)(A) (limiting judicial review to reconsideration of the Secretary's "final decision," reached at the conclusion of the administrative review process). The completion of the administrative review process, often referred to as the `exhaustion of administrative remedies,' is required before the Court can exercise jurisdiction. Salfi, 422 U.S. at 764, 766, 95 S.Ct. 2457 (holding a "final decision" is "central to the requisite grant of ... jurisdiction" and therefore is a "statutorily specified jurisdictional prerequisite" to suit); see also Ringer, 466 U.S. at 617-19, 104 S.Ct. 2013 (1984) (dismissing suit challenging the Secretary's actions under Medicare Part B due to failure to exhaust administrative remedies as required by 42 U.S.C. § 405(g)).
In this case, Plaintiff did not complete the administrative review process before bringing this action. In an attempt to get around the administrative exhaustion requirement, Plaintiff makes two arguments: (1) that exhaustion is not necessary in her case, and (2) that she tried to exhaust administrative remedies but was unsuccessful. Plaintiff's first argument is that because she is disabled, it is not necessary to obtain a "right-to-sue" letter before going to court. (Dkt. 21, Pl.'s Resp. 1). As Defendant states in its reply, however, the "right-to-sue" letter requirement (and any exceptions) come from the law of employment discrimination. (Dkt. 22, Def.'s Reply 2). Such concepts have no applicability to disputes arising under Medicare.
Plaintiff has neither exhausted the administrative remedies available to her, nor shown why the exhaustion requirement should be waived in this case. In light of this, and because of Supreme Court and Sixth Circuit precedent holding that satisfaction of the administrative exhaustion requirement is necessary for jurisdiction,
Because the Plaintiff's failure to exhaust administrative remedies deprives the Court of any subject matter jurisdiction over this case, the Court need not reach the question of whether Plaintiff has satisfied the jurisdictional "amount in controversy" requirement. The Court notes, however, that the Medicare Act allows for judicial review only in cases where the amount of the claim in controversy is greater than a certain statutory minimum (set at $1400 for claims in the calendar year 2013). This minimum required amount is adjusted annually to reflect increases in the "medical care component of the consumer price index." 42 U.S.C. §§ 1395ff(b)(1)(E)(i), 1395ff(b)(1)(E)(iii).
Plaintiff's failure to satisfy the Medicare Act's administrative exhaustion requirement prevents this court from exercising subject matter jurisdiction. Consequently, Defendant's Motion to Dismiss is