Califano v. Yamasaki

442 U.S. 682, 99 S. Ct. 2545, 61 L. Ed. 2d 176, 1979 U.S. LEXIS 132, 27 Fed. R. Serv. 2d 941
Supreme Court of the United States·Decided June 20, 1979·No. 77-1511·Published·Cited by 1,861 cases

Opinion

Me. Justice Blackmun

delivered the opinion of the Court.

Petitioner, the Secretary of the Department of Health, Education, and Welfare (HEW), has determined that respondents, beneficiaries under the Social Security Act, have been overpaid. He seeks to recoup those overpayments by withholding future benefits to which respondents would otherwise be entitled. Respondents in turn have requested reconsideration or waiver of recoupment under § 204 of the Act, 42 U. S. C. § 404. The primary questions in this case are whether petitioner must grant respondents the opportunity for an oral hearing before recoupment begins, and whether jurisdiction under § 205 (g) of the Act, 42 U. S. C. § 405 (g), permits a federal district court to certify a nationwide class and grant injunctive relief.

I

Section 204 (a)(1) of the Social Security Act, 53 Stat. 1368, as amended, 42 U. S. C. § 404 (a)(1), authorizes the recovery of overpayments made to a beneficiary under the old-age, survivors’, or disability insurance programs administered by HEW. In particular, it permits the Secretary to recoup *685 erroneous overpayments by decreasing future payments to which the overpaid person is entitled.

Section 204 (b), however, expressly limits the recoupment authority conferred by § 204 (a)(1). Section 204 (b), as set forth in 42 U. S. C. § 404 (b), commands that

“there shall be no adjustment of payments to, or recovery by the United States from, any person who is without fault if such adjustment or recovery would defeat the purpose of this subchapter or would be against equity and good conscience.” 1

The Secretary has undertaken to define the terms employed in § 204 (b). Under his regulations, “without fault” means that the recipient neither knew nor should have known that the overpayment or the information on which it was based was incorrect. 20 CFR § 404.507 (1978). For example, a recipient who justifiably relied upon erroneous information from *686 an official source within the Social Security Administration would be “without fault.” § 404.510.

The regulations say that to “defeat the purpose of the sub-chapter” is to “deprive a person of income required for ordinary and necessary living expenses.” §404.508 (a). Those expenses are defined to include, among other things, food, rent, and medical bills. §§404.508 (a)(1) and (2). Recoupment is “against equity and good conscience” when the recipient “because of a notice that such payment would be made or by reason of the incorrect payment, relinquished a valuable right ... or changed his position for the worse.” § 404.509. An example of detrimental reliance that would be sufficient is permitting private hospital insurance to lapse in the mistaken expectation of receiving federal hospital benefits. Ibid.

The Secretary's practice is to make an ex parte determination under § 204 (a) that an overpayment has been made, to notify the recipient of that determination, and then to shift to the recipient the burden of either (i) seeking reconsideration to contest the accuracy of that determination, or (ii) asking the Secretary to forgive the debt and waive recovery in accordance with § 204 (b). 2 If a recipient files a written request for reconsideration or waiver, recoupment is deferred pending action on that request. Social Security Claims Manual §§ 5503.2 (c), 5503.4 (b) (Dec. 1978) (Claims Manual). The papers are sent to one of the seven regional offices where the request is reviewed.

If the regional office decision goes against the recipient, recoupment begins. The recipient’s monthly benefits are reduced or terminated 3 until the overpayment has been re *687 couped. Only if the recipient continues to object is he given an opportunity to present his story in person to someone with authority to decide his case. That opportunity takes the form of an on-the-record de novo evidential hearing before an independent hearing examiner. 20 CFR, §§ 404.917, 404.931 (1978). The recipient may seek subsequent review by the Appeals Council, § 404.945, and finally by a federal court. § 205 (g) of the Act, 42 U. S. C. § 405 (g). If it is decided that the Secretary’s initial determination was in error, the amounts wrongfully recouped are repaid.

II

The Elliott Case 4

The Secretary overpaid the Hawaii respondents, 5 and notified them of his determination to recoup the overpayments. After unsuccessful attempts to obtain administrative relief, they brought suit in the United States District Court for the District of Hawaii challenging the legality of the Secretary’s recoupment procedures. They alleged that, because the *688 notice they received was inadequate and because they were not given an opportunity for an oral hearing before recoupment began, the recoupment procedures violated both § 204 of the Act and the Fifth Amendment of the Constitution. They sought class certification, and requested both declaratory and injunctive relief that would require the Secretary to cease future recoupment until such time as he provided the class with adequate notice and opportunity for a hearing. App. 11-21.

The District Court certified a class of “all social security old age and disability benefit recipients resident in the State of Hawaii, who are being or will be subjected to adjustment of their social security benefits pursuant to 42 U. S. C. §§ 404 (a) and (b) without adequate prior notice of the grounds for such action and without a prior hearing on disputed issues relating to such actions.” Id., at 35. The court found jurisdiction under the mandamus statute, 28 U. S. C. § 1361, and granted relief to respondents. The court said that due process required that the Secretary provide an opportunity for an informal oral hearing before an independent decisionmaker prior to recoupment. In so holding, the court relied on Goldberg v. Kelly, 397 U. S. 254

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Califano v. Yamasaki, 442 U.S. 682, 99 S. Ct. 2545, 61 L. Ed. 2d 176, 1979 U.S. LEXIS 132, 27 Fed. R. Serv. 2d 941 (1979).

442 U.S. 682 (Califano v. Yamasaki) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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