Crisci v. Shalala

169 F.R.D. 563, 1996 U.S. Dist. LEXIS 19267, 1996 WL 733013
CourtDistrict Court, S.D. New York
DecidedDecember 18, 1996
DocketNo. 95 Civ. 5269
StatusPublished
Cited by7 cases

This text of 169 F.R.D. 563 (Crisci v. Shalala) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Crisci v. Shalala, 169 F.R.D. 563, 1996 U.S. Dist. LEXIS 19267, 1996 WL 733013 (S.D.N.Y. 1996).

Opinion

OPINION

ROBERT J. WARD, District Judge.

Defendants Donna E. Shalala, Secretary of the Department of Health and Human Services (“the Secretary”), Irwin Bernstein, Chief Regional Administrative Law Judge (“ALJ Bernstein”), Helen Anyel, Administrative Law Judge (“ALJ Anyel”), and Ben L. Erdreich, Chairman of the Merit Systems Protection Board (“Chairman Erdreich”) (“defendants”) have moved pursuant to Rules 12(b)(1) and (b)(6), Fed.R.Civ.P., for an order dismissing plaintiffs’ complaint for lack of subject matter jurisdiction and for failure to state a claim upon which relief can be granted. Plaintiffs have moved, pursuant to Rule 23, Fed.R.Civ.P., for an order certifying this action as a class action on behalf of all Medicare Part B claimants whose claims have been, from January 1,1995 to the present, or will be, assigned to ALJ Anyel for hearing and decision. For the reasons hereinafter stated, defendants’ motion to dismiss is denied, and plaintiffs’ motion for class certification is granted.

[566]*566BACKGROUND

Individuals who are entitled to insurance benefits under Title II of the Social Security Act are eligible for federal reimbursement of certain health care expenses through the Medicare Program. 42 U.S.C. § 1395c. Under Part B of the Medicare Program, the federal government provides partial financing to voluntary enrollees for the costs of physicians’ services, out-patient hospital care and therapy, and diagnostic tests. 42 U.S.C. §§ 1395j-w. In order to obtain benefits under Part B, the claimant must submit a claim to one of the private insurance carriers who administer the program under a contract with the Secretary.

If the claimant is dissatisfied with the carrier’s calculation of the amount of benefits payable, and the amount in dispute exceeds $100, the claimant may request a fair hearing before an impartial hearing officer. The claimant may appeal a fair hearing decision to an administrative law judge if the amount in controversy is not less than $500. If the amount in dispute is at least $1,000, the claimant may seek Appeals Council review of an administrative law judge’s decision. Finally, the claimant is entitled to seek judicial review in federal court of an Appeals Council decision if the amount in controversy is at least $1,000.

Plaintiffs, on behalf of all claimants for Medicare Part B benefits whose claims have been, from January 1,1995 to the present, or will be, assigned to ALJ Anyel for hearing and decision, allege that ALJ Anyel is biased against Social Security claimants and lacks the temperament, impartiality, and ability to decide cases fairly. According to plaintiffs, ALJ Anyel’s unwillingness to follow and apply the law deprives claimants of the right to have their claims fairly considered in violation of the Social Security Act and the due process clause of the Fifth Amendment to the United States Constitution.

In support of their contentions, plaintiffs allege that ALJ Anyel has routinely forced unrepresented claimants to proceed pro se, even those who wished to obtain counsel; that she has been reversed several times for failing to develop adequately the record in cases involving pro se claimants; that she has failed to follow specific directions from reviewing courts; and that she has been openly hostile, intimidating and verbally abusive to claimants and their representatives. Additionally, plaintiffs cite to this Court’s decision finding that a class of individuals whose claims for Social Security or supplemental security income benefits (“SSI”) were denied by ALJ Anyel adequately alleged that ALJ Anyel’s biased conduct deprived them of the right to a fair and impartial hearing. Kendrick v. Sullivan, 784 F.Supp. 94 (S.D.N.Y.1992).

On May 15, 1991, the Social Security Administration (“SSA”) Office of Hearing and Appeals (“OHA”) filed a complaint with the Merit Systems Protection Board (“MSPB”) seeking to remove ALJ. Anyel. The complaint alleged that ALJ Anyel (1) failed to demonstrate an acceptable level of professional competence, legal knowledge, and informed judgment in the performance of her adjudicative functions, and (2) failed to extend adequately to pro se claimants the right to representation during hearings held before her. See SSA OHA v. Anyel, No. CB-7521-91-0009-B-1, Recommended Decision, Sept. 16, 1994, at 1. Following the recommended decision of Chief Administrative Law Judge Paul G. Strab, the MSPB approved a settlement agreement between OHA and ALJ Anyel on January 24, 1995. SSA OHA v. Anyel, 66 M.S.P.R. 328 (1995). The settlement agreement provided in relevant part: (1) that ALJ Anyel would be suspended for ninety days; (2) that, following her term of suspension, ALJ Anyel would receive one month of retraining in Social Security and Medicare law, and in the due process rights of claimants in administrative hearings; and (3) that, for at least one year following her term of suspension, ALJ Anyel would be prohibited from hearing cases under Titles II and XVI of the Social Security Act requiring the disposition of issues involving entitlement to disability benefits or SSI benefits. Under the settlement agreement, ALJ Anyel is not barred from hearing and deciding Medicare Part B claims.

ALJ Anyel returned to work on May 22, 1995. On June 22, 1995, ALJ Anyel sent notices to the named plaintiffs that their [567]*567Medicare Part B claims had been assigned to her, and that she would conduct hearings on those claims on July 27,1995. Plaintiffs filed the present action on July 14,1995. On July 27, 1995, it was Chief Administrative Law Judge Newton Greenberg (“Chief ALJ Greenberg”) rather than ALJ Anyel who heard the named plaintiffs’ claims. Plaintiffs allegedly received neither prior notice that their eases had been transferred to Chief ALJ Greenberg, nor an explanation for the transfer.

Defendants now request dismissal of plaintiffs’ complaint. Plaintiffs seek to have this action certified as a class action. The Court will address these applications in turn.

DISCUSSION

I. Defendants’ Motion to Dismiss

Defendants base their motion to dismiss on the grounds of mootness and lack of subject matter jurisdiction. This Court first will discuss the mootness issue, and then will consider whether it has subject matter jurisdiction to hear plaintiffs’ claims.

A Mootness

Defendants argue that because ALJ Anyel did not hold the July 27,1995 hearings on the named plaintiffs’ Medicare Part B claims, the named plaintiffs will not suffer the injury they allege in their complaint. According to defendants, because no actual controversy exists, and because plaintiffs’ claims are not capable of repetition, yet evading review, this action should be dismissed as moot.

Under the “case or controversy” requirement of Article III of the Constitution, a court must have before it a genuine dispute. McCoy v. Ithaca Housing Auth., 559 F.Supp. 1351, 1353 (N.D.N.Y.1983). Generally, a ease will become moot if “the plaintiff’s personal stake in the litigation [does not] continue throughout the entirety of the litigation.” Sosna v. Iowa, 419 U.S. 393, 402, 95 S.Ct. 553, 558-59, 42 L.Ed.2d 532 (1975).

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Bluebook (online)
169 F.R.D. 563, 1996 U.S. Dist. LEXIS 19267, 1996 WL 733013, Counsel Stack Legal Research, https://law.counselstack.com/opinion/crisci-v-shalala-nysd-1996.