What is the legal test for determining whether a contractor is entitled to pay for a service provided by the contractor?
MultiRegion, United States of America
The following excerpt is from Odell v. U.S. Dep't of Health & Human Servs., 995 F.3d 718 (9th Cir. 2021):
If the contractor determines that a service is covered, it pays the claim. 42 U.S.C. 1395l (a). Otherwise, it denies the claim. A party seeking reimbursement can then challenge the denial of coverage through four levels of administrative review. See Haro v. Sebelius , 747 F.3d 1099, 1114 (9th Cir. 2014). First, a party can
[995 F.3d 721]
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