42 U.S.C. § 1395oo : US Code - Section 1395OO: Provider Reimbursement Review Board

    (a) Establishment
      Any provider of services which has filed a required cost report
    within the time specified in regulations may obtain a hearing with
    respect to such cost report by a Provider Reimbursement Review
    Board (hereinafter referred to as the "Board") which shall be
    established by the Secretary in accordance with subsection (h) of
    this section and (except as provided in subsection (g)(2) of this
    section) any hospital which receives payments in amounts computed
    under subsection (b) or (d) of section 1395ww of this title and
    which has submitted such reports within such time as the Secretary
    may require in order to make payment under such section may obtain
    a hearing with respect to such payment by the Board, if - 
        (1) such provider - 
          (A)(i) is dissatisfied with a final determination of the
        organization serving as its fiscal intermediary pursuant to
        section 1395h of this title as to the amount of total program
        reimbursement due the provider for the items and services
        furnished to individuals for which payment may be made under
        this subchapter for the period covered by such report, or
          (ii) is dissatisfied with a final determination of the
        Secretary as to the amount of the payment under subsection (b)
        or (d) of section 1395ww of this title,
          (B) has not received such final determination from such
        intermediary on a timely basis after filing such report, where
        such report complied with the rules and regulations of the
        Secretary relating to such report, or
          (C) has not received such final determination on a timely
        basis after filing a supplementary cost report, where such cost
        report did not so comply and such supplementary cost report did
        so comply,

        (2) the amount in controversy is $10,000 or more, and
        (3) such provider files a request for a hearing within 180 days
      after notice of the intermediary's final determination under
      paragraph (1)(A)(i), or with respect to appeals under paragraph
      (1)(A)(ii), 180 days after notice of the Secretary's final
      determination, or with respect to appeals pursuant to paragraph
      (1) (B) or (C), within 180 days after notice of such
      determination would have been received if such determination had
      been made on a timely basis.
    (b) Appeals by groups
      The provisions of subsection (a) of this section shall apply to
    any group of providers of services if each provider of services in
    such group would, upon the filing of an appeal (but without regard
    to the $10,000 limitation), be entitled to such a hearing, but only
    if the matters in controversy involve a common question of fact or
    interpretation of law or regulations and the amount in controversy
    is, in the aggregate, $50,000 or more.
    (c) Right to counsel; rules of evidence
      At such hearing, the provider of services shall have the right to
    be represented by counsel, to introduce evidence, and to examine
    and cross-examine witnesses. Evidence may be received at any such
    hearing even though inadmissible under rules of evidence applicable
    to court procedure.
    (d) Decisions of Board
      A decision by the Board shall be based upon the record made at
    such hearing, which shall include the evidence considered by the
    intermediary and such other evidence as may be obtained or received
    by the Board, and shall be supported by substantial evidence when
    the record is viewed as a whole. The Board shall have the power to
    affirm, modify, or reverse a final determination of the fiscal
    intermediary with respect to a cost report and to make any other
    revisions on matters covered by such cost report (including
    revisions adverse to the provider of services) even though such
    matters were not considered by the intermediary in making such
    final determination.
    (e) Rules and regulations
      The Board shall have full power and authority to make rules and
    establish procedures, not inconsistent with the provisions of this
    subchapter or regulations of the Secretary, which are necessary or
    appropriate to carry out the provisions of this section. In the
    course of any hearing the Board may administer oaths and
    affirmations. The provisions of subsections (d) and (e) of section
    405 of this title with respect to subpenas shall apply to the Board
    to the same extent as they apply to the Secretary with respect to
    subchapter II of this chapter.
    (f) Finality of decision; judicial review; determinations of Board
      authority; jurisdiction; venue; interest on amount in controversy
      (1) A decision of the Board shall be final unless the Secretary,
    on his own motion, and within 60 days after the provider of
    services is notified of the Board's decision, reverses, affirms, or
    modifies the Board's decision. Providers shall have the right to
    obtain judicial review of any final decision of the Board, or of
    any reversal, affirmance, or modification by the Secretary, by a
    civil action commenced within 60 days of the date on which notice
    of any final decision by the Board or of any reversal, affirmance,
    or modification by the Secretary is received. Providers shall also
    have the right to obtain judicial review of any action of the
    fiscal intermediary which involves a question of law or regulations
    relevant to the matters in controversy whenever the Board
    determines (on its own motion or at the request of a provider of
    services as described in the following sentence) that it is without
    authority to decide the question, by a civil action commenced
    within sixty days of the date on which notification of such
    determination is received. If a provider of services may obtain a
    hearing under subsection (a) of this section and has filed a
    request for such a hearing, such provider may file a request for a
    determination by the Board of its authority to decide the question
    of law or regulations relevant to the matters in controversy
    (accompanied by such documents and materials as the Board shall
    require for purposes of rendering such determination). The Board
    shall render such determination in writing within thirty days after
    the Board receives the request and such accompanying documents and
    materials, and the determination shall be considered a final
    decision and not subject to review by the Secretary. If the Board
    fails to render such determination within such period, the provider
    may bring a civil action (within sixty days of the end of such
    period) with respect to the matter in controversy contained in such
    request for a hearing. Such action shall be brought in the district
    court of the United States for the judicial district in which the
    provider is located (or, in an action brought jointly by several
    providers, the judicial district in which the greatest number of
    such providers are located) or in the District Court for the
    District of Columbia and shall be tried pursuant to the applicable
    provisions under chapter 7 of title 5 notwithstanding any other
    provisions in section 405 of this title. Any appeal to the Board or
    action for judicial review by providers which are under common
    ownership or control or which have obtained a hearing under
    subsection (b) of this section must be brought by such providers as
    a group with respect to any matter involving an issue common to
    such providers.
      (2) Where a provider seeks judicial review pursuant to paragraph
    (1), the amount in controversy shall be subject to annual interest
    beginning on the first day of the first month beginning after the
    180-day period as determined pursuant to subsection (a)(3) of this
    section and equal to the rate of interest on obligations issued for
    purchase by the Federal Hospital Insurance Trust Fund for the month
    in which the civil action authorized under paragraph (1) is
    commenced, to be awarded by the reviewing court in favor of the
    prevailing party.
      (3) No interest awarded pursuant to paragraph (2) shall be deemed
    income or cost for the purposes of determining reimbursement due
    providers under this chapter.
    (g) Certain findings not reviewable
      (1) The finding of a fiscal intermediary that no payment may be
    made under this subchapter for any expenses incurred for items or
    services furnished to an individual because such items or services
    are listed in section 1395y of this title shall not be reviewed by
    the Board, or by any court pursuant to an action brought under
    subsection (f) of this section.
      (2) The determinations and other decisions described in section
    1395ww(d)(7) of this title shall not be reviewed by the Board or by
    any court pursuant to an action brought under subsection (f) of
    this section or otherwise.
    (h) Composition and compensation
      The Board shall be composed of five members appointed by the
    Secretary without regard to the provisions of title 5 governing
    appointments in the competitive services. Two of such members shall
    be representative of providers of services. All of the members of
    the Board shall be persons knowledgeable in the field of payment of
    providers of services, and at least one of them shall be a
    certified public accountant. Members of the Board shall be entitled
    to receive compensation at rates fixed by the Secretary, but not
    exceeding the rate specified (at the time the service involved is
    rendered by such members) for grade GS-18 in section 5332 of title
    5. The term of office shall be three years, except that the
    Secretary shall appoint the initial members of the Board for
    shorter terms to the extent necessary to permit staggered terms of
    office.
    (i) Technical and clerical assistance
      The Board is authorized to engage such technical assistance as
    may be required to carry out its functions, and the Secretary
    shall, in addition, make available to the Board such secretarial,
    clerical, and other assistance as the Board may require to carry
    out its functions.
    (j) "Provider of services" defined
      In this section, the term "provider of services" includes a rural
    health clinic and a Federally qualified health center.