Bloom v. Azar, 976 F.3d 157

Jonathan Bloom, a Medicare beneficiary with brittle Type I diabetes and hypoglycemic unawareness, uses a Continuous Glucose Monitoring (CGM) device to avoid life‑threatening hypoglycemia.
Bloom sought Medicare coverage repeatedly; the Medicare Appeals Council denied three claims: $473 (30‑day sensors), $1,976 (transmitter + sensors), and $1,419 (90‑day sensors).
Bloom sued to review the adverse Appeals Council decisions; the District Court held it lacked jurisdiction over the $473 and $1,419 denials because each was below the then $1,500 amount‑in‑controversy threshold and refused to allow aggregation of the claims.
The core statutory provision is 42 U.S.C. § 1395ff(b)(1)(E)(ii), which directs the Secretary to allow aggregation of two or more appeals involving similar/related services to the same individual by one or more providers when determining amount in controversy.
The Second Circuit vacated and remanded, holding that the Medicare Act permits a plaintiff to aggregate qualifying claims in district court to meet the amount‑in‑controversy requirement, relying on the statute’s text plus regulatory and legislative history.
The Court noted limits: exhaustion (claims must have been finally decided administratively), regulatory timing rules constrain how many claims may be aggregated, and HHS retains rulemaking authority over administrative aggregation.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the Medicare Act permits aggregation of multiple Medicare claims in district court to satisfy the amount‑in‑controversy requirement	Bloom: Yes—§1395ff(b)(1)(E)(ii) allows aggregation where claims involve related services to the same individual; aggregated value here exceeds the threshold	HHS: No—provision is directed to the Secretary and governs only agency aggregation; silence about judicial aggregation implies exclusion	Court: Aggregation is permitted in district court when statutory conditions are met; vacated district court dismissal and remanded

Snyder v. Harris, 394 U.S. 332 (U.S. 1969) (recognizing traditional aggregation of a single plaintiff's multiple claims against a single defendant)
United States v. Williams, 733 F.3d 448 (2d Cir. 2013) (standard of review: de novo review applied)
Brown & Williamson Tobacco Corp. v. FDA, 529 U.S. 120 (U.S. 2000) (statutory interpretation requires attention to regulatory backdrop)
NLRB v. Sw. Gen., Inc., 137 S. Ct. 929 (U.S. 2017) (limits on applying expressio unius canon; context matters)
Barnhart v. Peabody Coal Co., 537 U.S. 149 (U.S. 2003) (expressio unius applied only when exclusion is sensible in context)
Hunter v. United Van Lines, 746 F.2d 635 (9th Cir. 1984) (collecting authorities on aggregation under federal‑question jurisdiction)
Abbott Labs. v. Gardner, 387 U.S. 136 (U.S. 1967) (reviewability principles; mere reviewability of some acts does not imply exclusion of others)
Chevron U.S.A., Inc. v. Nat. Res. Def. Council, 467 U.S. 837 (U.S. 1984) (framework for evaluating agency statutory interpretations)
Bowles v. Seminole Rock & Sand Co., 325 U.S. 410 (U.S. 1945) (deference to reasonable agency interpretations of its own regulations)