On January 18, the United States Court of Appeals for the District of Columbia Circuit affirmed the dismissal of a telehealth provider’s lawsuit regarding the reimbursements of critical care telehealth services provided from outside the United States. The Plaintiff, RICU, LLC (RICU), is a telehealth provider that specializes in remote critical care services. The plaintiff contracts with approximately 60 intensive-care physicians who live and work abroad but were trained, certified, and licensed in the United States. These overseas physicians provide critical-care telehealth services to over 35 million Americans through more than 250 hospitals in 34 states. In response to the COVID-19 pandemic, the HHS allowed critical-care telehealth services to be reimbursed by Medicare through the end of the COVID-19 public health emergency. In April 2020, RICU had sought guidance from HHS on whether Medicare would reimburse telehealth services provided by physicians outside of the United States, and HHS replied in the negative. RICU then filed a complaint in the federal district court in February 2021, alleging that the HHS determination was contrary to law and arbitrary and capricious, but the complaint was dismissed for lack of subject matter jurisdiction. As described in the D.C. Circuit Court opinion, a plaintiff must satisfy two prerequisites for judicial review of Medicare claims: (1) a plaintiff’s claim must have been submitted to the agency and (2) a plaintiff must fully exhaust the administrative remedies. The circuit court ruled that judicial review is not available to RICU at this time, because RICU has yet to submit a specific claim to HHS for reimbursement.