David v. Sullivan

777 F. Supp. 212, 1991 U.S. Dist. LEXIS 16956, 1991 WL 239588
CourtDistrict Court, E.D. New York
DecidedNovember 13, 1991
Docket79 Civ. 2813
StatusPublished
Cited by19 cases

This text of 777 F. Supp. 212 (David v. Sullivan) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
David v. Sullivan, 777 F. Supp. 212, 1991 U.S. Dist. LEXIS 16956, 1991 WL 239588 (E.D.N.Y. 1991).

Opinion

MEMORANDUM, FINAL ORDER AND JUDGMENT

WEINSTEIN, District Judge:

After a full hearing of this matter by the court, the Magistrate Judge’s recommendations and findings are adopted for the reasons stated in her Report which is attached to, and made a part of, this order.

Plaintiffs’ counsel contend that the Magistrate Judge’s award of fees is based on rates that are somewhat low by Manhattan standards. The fees awarded are adequate to encourage attorneys to take on the important task of policing government practices. Added to the monetary incentive is the supplemental psychic incentive of recognition for a job well done from the bar, bench, and public, and personal satisfaction for performing a valued public service. Able attorneys in metropolitan New York should be sufficiently beguiled by this package of benefits to continue to pursue public interest litigation of this kind.

This case is closed.

So ordered.

REPORT AND RECOMMENDATION

ALLYNE R. ROSS, United States Magistrate Judge.

This action began over twelve years ago when plaintiffs — a class of Medicare beneficiaries who were enrolled in the supplementary medical insurance program established under Part B of the Social Security Act, 42 U.S.C. § 1395j et seq., but who had been denied reimbursement for certain medical costs — sued Group Health Incorporated (GHI), the carrier which administers the program in Queens, New York, and the Secretary of Health and Human Services (HHS), who is statutorily authorized to contract with private insurance carriers to administer the Part B claims process. Plaintiffs alleged, in substance, that the “review determination notices,” through which GHI supposedly informed plaintiffs of the results of the carrier’s internal review of its decision to deny benefits, were inadequate. Although Judge Weinstein resolved the primary issue in 1984, ruling that these notices did not meet due process standards and ordering that they be “changed to provide claimants with comprehensible explanations of the actual reason full reimbursement is denied,” David v. Heckler, 591 F.Supp. 1033, 1035 (E.D.N.Y.1984), there have been many subsequent proceedings in which details concerning this original order have been ironed out. In June 1990, plaintiffs moved, pursuant 28 U.S.C. § 2412, to recover the attorneys’ fees and costs they incurred during these post-judgment proceedings. After rendering a decision as to certain aspects of this motion, Judge Wein-stein referred this matter to me for a report and recommendation concerning all aspects of the fees request.

FACTS

The Procedural History

This class action, brought by plaintiffs’ counsel on behalf of “hundreds of thousands of older people in Queens, New York, whose Medicare Part B claims [were] subjected to diminution,” principally challenged the adequacy of notices and appeal procedures used by GHI, the insurance carrier who was authorized by HHS to administer the Part B claims process in this area. David v. Heckler, 591 F.Supp. at 1035. The dispute focused on the adequacy of GHI’s “review determination notices” (also referred to as “review letters”), which are sent to beneficiaries who challenge GHI’s refusal to reimburse them for certain medical costs in order to inform them of the results of GHI’s internal review of its initial decision to deny benefits. This dispute was largely resolved following a 1984 bench trial before Judge Weinstein; in David v. Heckler, 591 F.Supp. 1033, the judge ruled that the review determination notices were “constitutionally inadequate” *215 in that they were "incomprehensible to most of the people who receive them” and did “not contain enough information about why reimbursement was denied and how the reimbursable amount was calculated to enable an individual or his or her representative to effectively appeal the decision.” Id. at 1042. The judge also found that this lack of information pervaded all aspects of the review process, including the hearing stage, thereby presenting a due process problem which mandated certain modifications in procedures. Id. at 1046-47.

To cure these deficiencies, Judge Wein-stein ordered, inter alia, that defendants re-draft the review letters so as to 1) eliminate code words and confusing language and 2) insure that they were sufficiently clear and detailed so that beneficiaries could determine whether or not their reimbursement had been calculated correctly. The judge also directed defendants to furnish plaintiffs’ counsel with information necessary to ensure that the Plan B program was being properly administered. In so doing, the court praised plaintiffs’ counsel efforts, noting that plaintiffs might otherwise not be represented because 1) the relatively small claims made it uneconomical for them to obtain counsel, 2) no specialized bar, such as that which has developed to effectively protect the rights of Social Security recipients, was likely to develop to protect Medicare beneficiaries, and 3) it was difficult for the elderly to organize effective private organizations with the interest and resources necessary to provide a check on the system. Judge Wein-stein stated:

[O]ne organization has shown the interest and capacity necessary to investigate [Medicare violations] and obtain relief— Legal Services for the Elderly. In this case the organization provided highly skilled and aggressive representation for the class through Toby Golick, Esq. in conjunction with Julia Spring Esq. and Whitney North Seymour, Esq., acting pro bono in the highest traditions of the bar. Id. at 1048.

Following this decision, plaintiffs moved for an award of attorneys’ fees. This motion was withdrawn in May, 1986, however, after the parties reached an agreement on this issue. Their agreement was embodied in a stipulation, entered as an order by Judge Weinstein on May 17, 1985, which provided that plaintiffs would accept $74,-500 “in full settlement and discharge of their claim for attorneys’ fees and expenses under the Equal Access to Justice Act, 28 U.S.C. § 2412.” The motion at bar, therefore, does not seek to recover attorneys’ fees or costs related to the trial or pre-trial proceedings, but only to recover expenses relating to post-judgment proceedings which took place in 1987 and thereafter.

Plaintiffs initiated these post-judgment proceedings on April 2, 1987, by moving that defendants be held in contempt for failure to comply with the Court’s original July 11, 1984, ruling. Plaintiffs alleged, inter alia, that GHI had failed to simplify the review determination notices, but that HHS’s annual reviews had nonetheless found the carrier in perfect compliance with the 1984 order. While Judge Wein-stein denied this motion, he directed defendants to produce the review determination letters and other data analyzed during the government’s Fiscal Year (FY) 1985 and 1986 reviews.

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Cite This Page — Counsel Stack

Bluebook (online)
777 F. Supp. 212, 1991 U.S. Dist. LEXIS 16956, 1991 WL 239588, Counsel Stack Legal Research, https://law.counselstack.com/opinion/david-v-sullivan-nyed-1991.