MEMORANDUM ***

Dorothy Calabrese, M.D., and her patients Harriet and Gene Fahl, appeal pro se from the district court’s order affirming the Secretary of the Department of Health and Human Services’ decision that Cala-brese must reimburse Medicare for payments she received. We have jurisdiction under 28 U.S.C. § 1291. We review de novo the district court’s order. Maximum Comfort Inc. v. Sec’y of Health & Human Servs., 512 F.3d 1081, 1088 n. 6 (9th Cir. 2007). We affirm.

The district court properly affirmed the Secretary’s decision because the Secretary’s finding that Calabrese failed to provide sufficient documentation to warrant payment under Medicare was “supported by substantial evidence.” 42 U.S.C. § 405(g) (incorporated by reference in 42 U.S.C. § 1395ff(b)(1)(A)); Osenbrock v. Apfel, 240 F.3d 1157, 1162 (9th Cir. 2001); see also 42 U.S.C. § 1395y(a)(1)(A) (no payment may be made for services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury ... ”). Moreover, the Secretary’s conclusion that Calabrese was not excused from liability because she knew or should have known about the quality of patient records she was required to maintain was not “ ‘arbitrary, capricious, an abuse of discretion, or [in violation of] law.’ ” Maximum Comfort, 512 F.3d at 1088 (citation omitted).

Appellants’ remaining contentions are unpersuasive.

AFFIRMED.