Giove v. Weinberger

380 F. Supp. 364, 1974 U.S. Dist. LEXIS 7405
CourtDistrict Court, D. Maryland
DecidedJuly 29, 1974
DocketCiv. A. 73-358-M
StatusPublished
Cited by1 cases

This text of 380 F. Supp. 364 (Giove v. Weinberger) is published on Counsel Stack Legal Research, covering District Court, D. Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Giove v. Weinberger, 380 F. Supp. 364, 1974 U.S. Dist. LEXIS 7405 (D. Md. 1974).

Opinion

Memorandum Opinion and Order

JAMES R. MILLER, Jr., District Judge.

Plaintiff, the widow of Joseph Giove, has filed a complaint in this court challenging the determination of the Social Security Administration that the hospital care of her deceased husband after June 9, 1971, was “custodial” and thus specifically excluded from coverage under the “Medicare Act” by virtue of Title XVIII, § 1862(a)(9) of the Social Security Act, 42 U.S.C. § 1395y(a)(9). The amount of the hospital bill in question is agreed to be $878.35.

The defendant has moved to dismiss on the ground that the amount in controversy is less than the $1,000 jurisdictional requirement of § 1869(b) of the Act, 42 U.S.C. § 1395ff (b) (2).

In 1972, Congress generally amended the conditions under which a dissatisfied individual would be entitled to a hearing by the Secretary of Health, Education and Welfare (H.E.W.) and to judicial review of the final decision of the Secretary. Pub.L. 92-603, Title II, § 299o (Oct. 30, 1972), 86 Stat. 1464, 42 U.S.C. § 1395ff. In relevant part this provision is as follows:

“§ 1395ff. Determinations; appeals “(a) The determination of whether an individual is entitled to benefits under part A or part B, and the determination of the amount of benefits under part A, shall be made by the Secretary in accordance with regulations prescribed by him.
“(b)(1) Any individual dissatisfied with any determination under subsection (a) . . . as to—
“(A) whether he meets the conditions of section 426 or 426a of this title, or
“(B) whether he is eligible to enroll and has enrolled pursuant to the provisions of part B of this sub-chapter, or section 1395i—2 of this title or section 1819, or
“(C) the amount of benefits under part A (including a determination where such amount is determined to be zero)
shall be entitled to a hearing thereon by the Secretary to the same extent as is provided in section 405(b) of this title and to judicial review of the Secretary’s final decision after such hearing as is provided in section 405(g) of this title.
“(2) Notwithstanding the provisions of subparagraph (C) of paragraph (1) of this subsection, a hearing shall not be available to an individual by reason of such subparagraph (C) if the amount in controversy is less than $100; nor shall judicial re *367 view be available to an individual by reason of such subparagraph (C) if the amount in controversy is less than $1,000.”

The amended § 1395ff applies in the instant case because this action was not filed until April 13, 1973, subsequent to the date of passage of the amendment. Pub.L. 92-603, § 2990(b).

“Part A,” referred to in § 1395ff, is the designation for that section of the Medicare Act establishing the broad general framework of eligibility for and operation of a basic program of hospital insurance benefits for the aged and disabled. 42 U.S.C. §§ 1395c—1395Í-2. “Part B,” referred to in § 1395ff, is the designation for that section of the Medicare Act establishing the broad general framework of eligibility for and operation of a program of supplemental medical insurance for qualified aged and disabled persons. 42 U.S.C. §§ 1395j-1395w. “Part C,” not directly referred to in § 1395ff, is the designation for that section of the Medicare Act which contains miscellaneous provisions of the Act. 42 U.S.C. §§ 1395x-1395pp.

The pre-1972 statute as it provided for judicial review stated:

“§ 1395ff
“(b) ... in the case of a determination as to entitlement or as to amount of benefits where the amount in controversy is $1000 or more, to judicial review of the Secretary’s final decision after such hearing as is provided in section 405(g) . . . . ” (Emphasis supplied).

In her amended complaint, plaintiff alleged jurisdiction alternatively under 42 U.S.C. § 1395ff(b), 42 U.S.C. § 405(g), 5 U.S.C. §§ 701-704, 28 U.S.C. § 1361, and 28 U.S.C. §§ 2201-2202.

I

The first theory of jurisdiction rests upon the premise that the Secretary’s action in denying the claim was based upon a finding that the decedent did not meet the conditions of 42 U.S.C. § 426. If true, the Secretary’s action would clearly be subject to judicial review under 42 U.S.C. § 1395ff(b) (1) (A).

Section 426(a) states, in essence, that individuals who have reached age 65 and are entitled to receive Social Security retirement benefits (both conditions were concededly met here) are entitled to Medicare benefits for as long as they are entitled to retirement benefits. However, notes plaintiff, § 426(c) provides that, for the purposes of subsection (a), “ . . . entitlement of an individual to hospital insurance benefits for a month shall consist of entitlement to have payments made under, and subject to the limitations in, Part A of subehapter XVIII . . . during such month. . . . ” Plaintiff argues that this reference to the “limitations” in Part A is a further condition of entitlement which adds something to § 426(a) and incorporates into § 426 all the limitations set out in Part A. Therefore, concludes plaintiff, a determination that the last 13 days of Mr. Giove’s hospital stay did not constitute “covered” care was, in effect, a decision that Mr. Giove did not meet “the conditions of” § 426.

By this argument plaintiff has read too much into § 426(c). No case law supporting plaintiff’s view of § 426 is cited, nor could this court find any. Section 426(c) on its face, only defines entitlement under § 426(a); it does not provide new conditions. Section 426 does not purport to lay down all the conditions for payment of benefits, only the conditions which must be met for entitlement to benefits. “Entitlement” in § 426, unlike its use in the previous § 1395ff, (see Ridgely v. Sec’y of Dept. of H.E.W., 475 F.2d 1222 (4th Cir.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Melson v. Secretary of Health and Human Services
702 F. Supp. 997 (W.D. New York, 1988)

Cite This Page — Counsel Stack

Bluebook (online)
380 F. Supp. 364, 1974 U.S. Dist. LEXIS 7405, Counsel Stack Legal Research, https://law.counselstack.com/opinion/giove-v-weinberger-mdd-1974.