Duquesne Law Review


David W. Thomas


Under the Medicare health insurance program, medical care providers, such as hospitals, submit claims for reimbursement of medical expenses to fiscal intermediaries. The fiscal intermediaries, usually private insurance companies operating as links between providers and the Department of Health and Human Services, then determine whether the claims warrant reimbursement with Medicare funds. As a consequence of this process, disputes often arise between providers and fiscal intermediaries. These disputes must be presented to the Provider Reimbursement Review Board. The continuing confusion surrounding the Board's jurisdiction over certain claims and the Board's scope of review prompted the author to explain the genesis of this confusion. Ultimately, the author provides a unified theory to resolve this confusion.

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