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INTERN. REHABILITATIVE SCIENCES INC. v. SEBELIUS

No. 11-35254.

688 F.3d 994 (2012)

INTERNATIONAL REHABILITATIVE SCIENCES INC., a Washington corporation, DBA RS Medical, Plaintiff-Appellee, v. Kathleen SEBELIUS, in her official capacity as Secretary, United States Department of Health and Human Services; United States Department of Health and Human Services, Defendants-Appellants.

United States Court of Appeals, Ninth Circuit.

Filed July 30, 2012.

Attorney(s) appearing for the Case

Debra M. Parrish (argued), Parrish Law Offices, Pittsburgh, PA, and Renee M. Howard and Sanford E. Pitler, Bennett Bigelow & Leedom, P.S., Seattle, WA, for the plaintiff-appellee.

Irene M. Solet (argued), Tony West, Jenny A. Durkan, Kerry Keefe, and Michael S. Raab, United States Department of Justice, Washington, D.C., and William B. Schultz, Pamela Parker, Janice L. Hoffman, Mark D. Polston, Janet Freeman, Brett Bierer, and Gerard Keating, United States Department of Health and Human Services, Washington, D.C., for the defendants-appellants.

Before: BARRY G. SILVERMAN and MARY H. MURGUIA, Circuit Judges, and LESLIE E. KOBAYASHI, District Judge.

OPINION

SILVERMAN, Circuit Judge:

The Department of Health and Human Services, the agency that administers Medicare, denied Medicare coverage for the BIO-1000, a piece of durable medical equipment used to treat osteoarthritis of the knee. In four decisions, the Medicare Appeals Council, which is the highest level of agency adjudication, ruled that the BIO-1000 had not been shown to be "reasonable and necessary" for the treatment at issue. The supplier of...

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