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Administrative – Medicare – Reimbursement – 1995 & 1997 Guidelines – Estoppel – Dated Record – Medical Complexity (access required)

Ojebuoboh v. Sebelius The plaintiff-doctor did not raise the issue of which set of Medicare Guidelines (the 1995 version or the 1997 version) applied until his motion for reconsideration before the Medicare Appeals Council (MAC). Accordingly, the MAC’s adoption of the independent reviewer’s decision to use the 1997 guidelines was not arbitrary, capricious, or an abuse of discretion.

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