Office of Hearings and Appeals
Social Security Administration (S.S.A.)
Department of Health and Human Services
Division IV: Civil Action
Subject: New Court Cases
June 30, 1994
Current through June 1997
I-4-134 AFFIDAVITS--AMOUNT IN CONTROVERSY LESS THAN $1,000 (MEDICARE)--$2,000 IN PEER REVIEW ORGANIZATION (PRO) CASES
When a claimant files a civil action on a Medicare claim, the analyst must determine if the amount in controversy is at least $1,000; $2,000 in PRO cases. If it is not, section 1869(b) of the Act (section 1155 of the Act in PRO cases) does not authorize judicial review and the analyst must prepare an affidavit using the fill-in draft in > I-4-199, Exhibit H1 or H2.
B. Using the Fill-in Draft Affidavit
The analyst must insert all identifying information in the blank spaces. Thereafter, the analyst must set forth the pertinent facts relating to the amount in controversy. Attach all relevant documents as exhibits to the affidavit.