Andrew Averett v. United States Dep't of Health & Human Servs., 943 F.3d 313

The Affordable Care Act temporarily increased payments to primary-care physicians under parallel Medicare (§1395l(x)) and Medicaid (§1396a(a)) provisions.
The Medicare provision expressly required (1) a “primary specialty designation” and (2) that at least 60% of recent Medicare billings be for primary-care services; the Medicaid provision required only the “primary specialty designation.”
CMS’s Final Medicare Payment Rule tracked the Medicare text, treating the physician’s own enrollment/self-designation as the primary-specialty designation and applying the 60% Medicare-billing test where the statute required it.
CMS’s Final Medicaid Payment Rule, by contrast, added verification requirements: a physician had to be board-certified in the specialty or show that 60% of recent Medicaid billings were for primary-care services.
Tennessee sought to recoup roughly $2.3 million paid to 21 family-medicine physicians under the Medicaid provision based on the CMS rule; the physicians sued, and the district court invalidated the Final Medicaid Payment Rule and enjoined its enforcement.
The Sixth Circuit affirmed, holding CMS’s added board-certification/60% Medicaid-billing requirements contradicted the statutory text.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether CMS lawfully interpreted “a physician with a primary specialty designation” in §1396a(a) to require board certification or a 60%-of-Medicaid-billings test	The phrase means the physician’s own primary-specialty self-designation (as CMS treated the identical Medicare phrase); Congress omitted any 60% requirement from Medicaid	CMS says it must verify specialty for Medicaid and may impose board certification or a 60%-billing test to limit payments	The court held the phrase must mean the same self-designation as in the Medicare provision; CMS’s additional requirements are invalid

Chevron U.S.A., Inc. v. Nat. Res. Def. Council, Inc., 467 U.S. 837 (1984) (framework for reviewing agency statutory interpretations)
Powerex Corp. v. Reliant Energy Servs., Inc., 551 U.S. 224 (2007) (identical words in same statute normally have same meaning)
Erlenbaugh v. United States, 409 U.S. 239 (1972) (legislature generally uses a word with consistent meaning in a given context)
SAS Inst., Inc. v. Iancu, 138 S. Ct. 1348 (2018) (agencies must follow plain statutory text and not add requirements)
United States v. Ressam, 553 U.S. 272 (2008) (omission of a phrase in a parallel statute implies different meaning)
Friends of the Earth, Inc. v. Laidlaw Envtl. Servs., 528 U.S. 167 (2000) (requirements for redressability and injunctive relief)
Prewett v. Weems, 749 F.3d 454 (6th Cir. 2014) (omission inference in statutory interpretation)
In re United States, 817 F.3d 953 (6th Cir. 2016) (elementary statutory-interpretation principles applied)