SHUNG v. SECRETARY OF HEALTH & HUMAN SERVICES

1
UNITED STATES DISTRICT COURT FOR THE
NORTHERN DISTRICT OF FLORIDA
PENSACOLA DIVISION
JOHN SHUNG,
Plaintiff,
vs. 	Case No.: 3:25cv120/MCR/ZCB
SECRETARY OF HEALTH &
HUMAN SERVICES,
Defendant.
/
REPORT AND RECOMMENDATION
Plaintiff, proceeding pro se, seeks judicial review of the Medicare
Appeals Council’s decision denying his claim for payment of two lab tests.
(Doc. 1). Defendant, Secretary of Health and Human Services, has moved
to dismiss. 	(Doc. 16). 	Plaintiff has responded in opposition. 	(Doc. 18).
For the reasons below, Defendant’s motion should be granted.
I. 	Factual and Procedural Background1
In his complaint, Plaintiff alleges that his doctor ordered two lab
tests to be completed “to diagnose [Plaintiff’s] underweight problem.”
(Doc. 1 at 5). 	Plaintiff received lab work from LabsMD and MyMedLab.
1 	At 	the 	motion 	to 	dismiss 	stage, 	the 	Court 	assumes 	the 	factual
“allegations in the complaint are true (even if doubtful in fact).” Bell Atl.
Corp. v. Twombly, 550 U.S. 544, 557 (2007).
Case 3:25-cv-00120-MCR-ZCB Document 19 Filed 11/20/25 Page 1 of 5

2
(Id.). Medicare denied coverage for Plaintiff’s lab work, and he was forced
to pay for the lab services. (Id.; Doc. 18 at 1).
Plaintiff appealed the coverage denial to the Medicare Independent
Review Entity, which upheld the denial. 	(Doc. 18 at 1). 	Plaintiff then
requested a hearing before an Administrative Law Judge (ALJ) in the
Office of Medicare Hearings and Appeals. 	(Doc. 1-1 at 10-11). 	The
hearing was held on June 28, 2024, and the ALJ found coverage had been
properly denied. 	(Doc. 1-1 at 12-20). 	Plaintiff appealed the ALJ’s
decision to the Medicare Appeals Council. The Medicare Appeals Council
affirmed the ALJ’s decision on January 15, 2025. (Doc. 1-1 at 1).
II. 	Discussion
Defendant has moved to dismiss based on lack of subject matter
jurisdiction. 	See Fed. R. Civ. P. 12(b)(1). 	Federal courts are courts of
limited jurisdiction. Bishop v. Reno, 210 F.3d 1295, 1298 (11th Cir. 2000).
If a federal court “determines at any time that it lacks subject-matter
jurisdiction, the court must dismiss the action.” Fed. R. Civ. P. 12(h)(3).
Generally, there are two categories of federal subject matter jurisdiction:
(1) federal question jurisdiction (28 U.S.C. § 1331); and (2) diversity
jurisdiction (28 U.S.C. § 1332). Baltin v. Alaron Trading Corp., 128 F.3d
Case 3:25-cv-00120-MCR-ZCB Document 19 Filed 11/20/25 Page 2 of 5

3
1466, 1469 (11th Cir. 1997). The party asserting federal jurisdiction has
the burden of showing that the case falls into one of the two categories.
Loren v. Sasser, 309 F.3d 1296, 1304 (11th Cir. 2002) (per curiam).
This 	case 	falls 	within 	the 	first 	category—federal 	question
jurisdiction under 28 U.S.C. § 1331. Federal question jurisdiction exists
“only when a federal question is presented on the face of” the well-pleaded
complaint, such as when federal law creates the cause of action that the
plaintiff says entitles him to relief. Caterpillar, Inc. v. Williams, 482 U.S.
386, 392 (1987). 	The federal law giving rise to the cause of action in this
case is 42 U.S.C. § 1395w-22(g)(5).
Under that statute, a Medicare enrollee who has been denied
coverage for a “health service” may seek judicial review of the Secretary’s
decision denying coverage “[i]f the amount in controversy is $1,000 or
more.” 42 U.S.C. § 1395w-22(g)(5). Thus, “judicial review is not available
for a claim with an amount in controversy less than $1,000.” 	Acquisto v.
Secure 	Horizons, 	504 	F. 	App’x 	855, 	856 	(11th 	Cir. 	2013). 	This
jurisdictional amount is subject to adjustment for inflation. 42 U.S.C. §
1395ff(b)(1)(E)(i); 42 U.S.C. § 1395w-22(g)(5). 	The applicable adjusted
jurisdictional amount in this case is $1,900. 	(See Doc. 16 at 4); 89 Fed.
Case 3:25-cv-00120-MCR-ZCB Document 19 Filed 11/20/25 Page 3 of 5

4
Reg. 	79294-03, 	79295, 	2024 	WL 	4299304 	(Sept. 	27, 	2024) 	(“The
adjustment to the AIC threshold amounts will be effective for requests
for ALJ hearings and judicial review filed on or after January 1, 2025.
The 	calendar 	year 	2025 	AIC 	threshold 	amounts 	are 	$190 	for 	ALJ
hearings and $1,900 for judicial review.”). 	If a plaintiff seeks judicial
review 	of 	a 	Medicare 	coverage 	denial 	that 	involves 	less 	than 	the
jurisdictional threshold, then dismissal is required for lack of subject
matter 	jurisdiction. 	See 	Acquisto, 	504 	F. 	App’x 	at 	856 	(affirming
dismissal for lack of subject matter jurisdiction where the plaintiff
seeking to challenge a Medicare coverage denial failed to establish that
the amount in controversy exceeded the threshold amount).
In this case, Defendant argues that subject matter jurisdiction is
lacking because Plaintiff seeks $1,480.68 (the cost Plaintiff paid for the
two labs), which is less than the inflation-adjusted amount in controversy
requirement of $1,900. 	(Doc. 16 at 4, 7). 	Plaintiff, for his part, argues
that he spent $1,658.62 instead of the $1,480.68 Defendant asserts he
spent. (Doc. 18 at 2). But both amounts fall short of the $1,900 threshold.
The 	Court, 	therefore, 	lacks 	subject 	matter 	jurisdiction 	because 	the
amount in controversy requirement in 42 U.S.C. § 1395w-22(g)(5) has not
Case 3:25-cv-00120-MCR-ZCB Document 19 Filed 11/20/25 Page 4 of 5

5
been met. Dismissal is required. See Woods v. Sec’y, U.S. Dep’t of Health
& Hum. Servs., No. 24-11815, 2025 WL 80284 (11th Cir. Jan. 13, 2025)
(affirming 	dismissal 	of 	plaintiff’s 	complaint 	for 	failure 	to 	meet 	the
amount in controversy requirement for judicial review).
III. 	Conclusion
For the reasons above, it is respectfully RECOMMENDED that:
1. Defendant’s motion to dismiss (Doc. 16) be GRANTED; and
2. The Clerk of Court be directed to enter judgment accordingly and
close the case.
At Pensacola, Florida, this 20th day of November 2025.
/s/
Zachary C. Bolitho
Zachary C. Bolitho
United States Magistrate Judge
Notice to the Parties
Objections to these proposed findings and recommendations must
be 	filed 	within 	fourteen 	days 	of 	the 	date 	of 	the 	Report 	and
Recommendation. 	Any 	different 	deadline 	that 	may 	appear 	on 	the
electronic docket is for the Court’s internal use only and does not control.
An objecting party must serve a copy of the objections on all other parties.
A 	party 	who 	fails 	to 	object 	to 	the 	magistrate 	judge’s 	findings 	or
recommendations contained in a report and recommendation waives the
right 	to 	challenge 	on 	appeal 	the 	district 	court’s 	order 	based 	on
unobjected-to factual and legal conclusions. 	See 11th Cir. Rule 3-1; 28
U.S.C. § 636.
Case 3:25-cv-00120-MCR-ZCB Document 19 Filed 11/20/25 Page 5 of 5