On January 3, the Fifth Circuit ruled that a defunct diagnostic testing laboratory may sue HHS to determine the amount HHS owes for money initially recouped under an overpayment decision that was later reversed. In 2014, a Medicare integrity contractor found that HHS overpaid more than $8 million to D&G Holdings, LLC (“D&G”) and the agency started recoupment. D&G then successfully challenged the finding through the agency review process. However, the Medicare Appeals Council did not determine the amount of money that Medicare wrongfully recouped during the administrative challenge. In D&G Holdings, LLC v. Becerra, No. 20-30732, 2022 Us App Lexis 55 (5th Cir. Jan. 03, 2022), D&G sought to collect the amount wrongfully recouped by Medicare in the federal court. The Fifth Circuit analyzed whether the claim may be brought in a federal court before administrative remedies have been exhausted. The Court held that the US Supreme Court’s holding in Shalala v. Illinois Council on Long Term Care Inc., 529 U.S. 1, (2000), on whether and when judicial review may be available pursuant to under 42 U.S.C. § 405(g) applied in this circumstance. This case represents another scenario where the federal courts have exercised jurisdiction over Medicare-related claims that have not been presented to the agency and administratively exhausted.