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UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
_______________________
No. 99-20075
_______________________
CAMILLE MORRIS, The Estate,
Plaintiff-Appellant,
versus
DONNA E. SHALALA, SECRETARY, DEPARTMENT OF HEALTH & HUMAN
SERVICES, of the United States,
Defendant-Appellee.
_________________________________________________________________
Appeal from the United States District Court
for the Southern District of Texas
_________________________________________________________________
March 22, 2000
Before JONES, DUHи, and WIENER, Circuit Judges.
PER CURIAM:
At issue in this case is the government's liability for
up to 30 days of skilled nursing services available under the
Medicare program.1 See 42 U.S.C. її 1395d(a)(2)(A), 1395x(h); 42
C.F.R. ї 409.20. After considering the applicable standard of
review for the decision of the Secretary of HHS, we conclude that
the denial of additional benefits was supported by substantial
evidence. The judgment of the district court is affirmed.
The outcome of this case does not depend upon the
standard employed by this court to review HHS's Medicare treatment
1
Appellant is the estate of the Medicare beneficiary Mrs. Camille
Morris. We refer to appellant as "Morris" for the sake of convenience. Mrs.
Morris was reimbursed for 70 of the 100 days maximum authorized by Medicare for
post-hospital, extended care services.

decisions concerning individual patients. Appellant disputes the
standard, however, so we begin by articulating it.
As the Secretary contends, 42 U.S.C. ї 1395ff(b) provides
that any individual who is dissatisfied with the Secretary's
decision regarding a claim to benefits is entitled to a hearing and
to review of the final decision as provided in section ї 405(g).
42 U.S.C. ї 405(g) provides, in relevant part:
Any individual, after any final decision of the
Commissioner of Social Security made after a hearing to
which he was a party, . . . may obtain a review of such
decision by a civil action . . . . Such action shall be
brought in the district court of the United States . . .
. The court shall have power to enter . . . a judgment
affirming, modifying, or reversing the decision of the
Commissioner of Social Security . . . . The findings of
the Commissioner of Social Security as to any fact, if
supported by substantial evidence, shall be conclusive .
. . . (emphasis added).
By its own terms, the Medicare Act seems to provide for a
substantial evidence standard of review. This is the view taken by
the Second Circuit in a case on point. Hurley v. Bowen, 857 F.2d
907, 912 (2d Cir. 1988); see also Ridgely v. Secretary of
Department of Health, Education & Welfare, 475 F.2d 1222, 1224 (4th
Cir. 1973) (noting that the district court properly applied the
substantial evidence test to the Secretary's findings).
Further, in Social Security disability review cases,
where ї 405(g) governs the standard of review, Frith v. Celebrezze,
333 F.2d 557, 560 (5th Cir. 1964), the Fifth Circuit has held that
appellate review is limited to two issues: (1) whether the
Commissioner applied the proper legal standards; and (2) whether
the Commissioner's decision is supported by substantial evidence on
2

the record as a whole. Paul v. Shalala, 29 F.3d 208, 210 (5th Cir.
1994); Anthony v. Sullivan, 954 F.2d 289, 292 (5th Cir. 1992).
Disability-benefits review cases seem indistinguishable from
Medicare-benefits review cases, and since review in both derives
from the same source, ї 405(g), both should employ the same
standard.
Notwithstanding these authorities, Morris contends that
the standard of review is found in the Administrative Procedure Act
("APA"). But the estate cites Hennepin County Medical Center v.
Shalala, 81 F.3d 743 (8th Cir. 1996), which did not arise from an
individual's appeal of a Secretary's denial of benefits under 42
U.S.C. ї 1395ff(b). Hennepin instead involved a provider's appeal
under 42 U.S.C. ї 1395oo(f)(1) for reimbursement of unrecovered
expenses incurred by Medicare patients.2 As ї 1395oo(f)(1) does
not incorporate ї 405(g), Hennepin is inapposite. The ї 405(g)
standard controls.
This court may not overturn the Secretary's decision if
it is supported by substantial evidence -- "more than a mere
scintilla"3 -- and correctly applies the law. Anthony, 954 F.2d at
292. Morris does not challenge any legal interpretation but only
the Secretary's factual conclusion that she did not utilize or need
skilled nursing care or physical therapy after May 31, 1994. We
2
A Fifth Circuit case also uses the APA standard of review in the
Medicare provider context: Harris County Hosp. District v. Shalala, 64 F.3d 220
(5th Cir. 1995).
3
Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 1427 (1971).
Richardson also defines the standard as requiring such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion. Id.
3

agree with the Second Circuit that coverage decisions "should be
based upon a common sense, non-technical consideration of the
patient's condition as a whole" and that the Act "is to be
liberally construed in favor of the beneficiaries." Hurley, 857
F.2d at 912. Even so, Morris cannot prevail. Extensive evidence
was admitted in the administrative hearing, including records from
The Forum nursing home, where Mrs. Morris lived after leaving the
hospital, testimony and records of her treating physician, and
testimony of a physician retained by the Secretary. Based on this
evidence, the Secretary could easily conclude that Mrs. Morris did
not qualify for reimbursement of skilled nursing care or physical
therapy under the regulations and that she was receiving and needed
only custodial care at the Forum during the relevant period. The
substantial evidence test is satisfied.
The judgment of the district court, which affirmed the
denial of additional Medicare benefits, is AFFIRMED.
4