HANDRON v. Sebelius

669 F. Supp. 2d 490, 2009 U.S. Dist. LEXIS 100490, 2009 WL 3584342
CourtDistrict Court, D. New Jersey
DecidedOctober 27, 2009
DocketCivil 08-3119 (RBK/KMW)
StatusPublished
Cited by3 cases

This text of 669 F. Supp. 2d 490 (HANDRON v. Sebelius) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
HANDRON v. Sebelius, 669 F. Supp. 2d 490, 2009 U.S. Dist. LEXIS 100490, 2009 WL 3584342 (D.N.J. 2009).

Opinion

*492 OPINION

KUGLER, District Judge.

This case poses a simple question with a difficult answer: What do the words “or otherwise” mean in the Equal Access to Justice Act (EAJA), 5 U.S.C. § 504? This question comes before the Court upon the Motion for Summary Judgment by Plaintiff Dr. John D. Handron (Docket No. 10). Plaintiff asks the Court to award him attorneys’ fees incurred while successfully defending against alleged Medicare overpayment before the Department of Health and Human Services. Because the Court finds that the position of the United States was not represented by counsel or otherwise as required by the EAJA, Plaintiffs motion is denied and the case is dismissed.

I. BACKGROUND

The following facts are deemed undisputed and are taken entirely from Plaintiffs moving papers. Under Local Civil Rule 56.1, the movant in a summary judgment motion is required to supply the court with a statement that sets forth the material facts to which no genuine issue exists. L. Civ. R. 56.1(a). Plaintiff supplied the required Rule 56.1 statement here. Rule 56.1 also requires that the non-movant furnish a responsive statement of material facts. Id. Any material fact not disputed is deemed undisputed. Id. Where the non-movant fails to supply the counter Rule 56.1 statement altogether, the court can treat all properly support facts by the movant as uncontroverted. Appleby v. Glaxo Wellcome, Inc., Civ. No. 04-0062, 2005 WL 3440440, at *2 (D.N.J. Dec. 13, 2005). In this case, Defendant Kathleen Sebelius 1 did not supply the required Rule 56.1 statement. 2 Therefore, because the Court finds that Plaintiffs material facts are well supported, the following facts are uncontroverted.

In 2001, Empire Medicare Services began collecting records from various nursing homes where Dr. Handron, a psychologist, treated patients. In March 2002, Eastern Benefits Integrity Center (EABISC), a contractor of the Department of Health and Human Services (HHS), informed Dr. Handron that it would suspend all future Medicare payments owed to him for services rendered. On August 20, 2003, Empire sent Dr. Handron a letter (the Demand Letter) asserting a Medicare overpayment of $604,038 for services provided between November 1, 1994 and January 31, 2001. The Demand Letter was based on a review of Dr. Handron’s records by EA-BISC. In the Demand Letter, Empire alleged that HHS had overpaid Dr. Handron in the amount of $125,696.71, and from that overpayment, Empire extrapolated that HHS had overpaid Dr. Handron $604,038 over his entire claims history.

The basis for the alleged overpayment was Section 1862(a)(1) of Title XVIII of the Social Security Act, which excludes payment by Medicare for services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of the malformed body member.” PI. 56.1 stmt, at ¶ 8. Specifically, the Demand Letter alleged that Dr. Handron’s psychotherapy and diagnostic testing services did not comply with the documentation, level of *493 care, and medical necessity requirements for payment under the Medicare Program.

Dr. Handron appealed the overstatement determination to a Fair Hearing Officer of the Department of Health and Human Services in September 2005. The Fair Hearing Officer upheld most of the overstatement determination, reducing the repayment obligation only slightly to $602,454.29. Dr. Handron appealed the Fair Hearing Officer’s determination, and a two day evidentiary hearing was held before the Honorable Phillip McAfee, Administrative Law Judge. On September 19, 2007, the ALJ rendered a decisions substantially reducing the overpayment determination to a mere $5,434.48. The reduction was based on a detailed review of approximately 25 boxes of records, expert testimony, and extensive review of the overpayment calculation.

Dr. Handron was represented by counsel during the ALJ proceeding, and indeed had been represented by counsel since November 2001. Therefore, because of Dr. Handron’s success, he filed an application under the Equal Access to Justice Act, 5 U.S.C. § 504, on December 13, 2007 for attorneys’ fees and costs in the amount of $59,525 and $5,848.93 respectively.

On February 19, 2008, the ALJ denied Dr. Handron’s EAJA application because he found that the proceedings did not constitute an “adversary adjudication” under the Act, and thus the Act did not apply. Compl., Ex. C. at 8. On March 18, 2008, Dr. Handron filed an appeal of the ALJ’s decision to the Medicare Appeals Council (MAC) of the Department of Health and Human Services. Because the MAC apparently lost Dr. Handron’s appeal, he resubmitted it on May 13, 2008. Thereafter, on May 22, 2008, the MAC adopted the ALJ’s decision, likewise finding that the EAJA did not apply because the proceedings did not constitute an “adversary adjudication.” Compl., Ex. E at 8.

Plaintiff filed a complaint in this Court on June 23, 2008 to appeal the MAC’s decision. Plaintiff filed a motion for summary judgment on March 16, 2009. Defendant filed a brief in opposition on May 27, 2009. 3 On October 13, 2009, the Court ordered Plaintiff to file a brief demonstrating subject matter jurisdiction over the matter. The Plaintiff complied on October 16, 2009, and the Court now holds that it has subject matter jurisdiction and that this matter is ripe for determination.

II. STANDARD

Summary judgment is appropriate where the court is satisfied that “there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c). A genuine issue of material fact exists “if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986). “In considering a motion for summary judgment, a district court may not make credibility determinations or engage in any weighing of the evidence; instead, the non-moving party’s evidence ‘is to be believed and all justifiable inferences are to be drawn in his favor.’ ” Marino v. Indus. Crating Co., 358 F.3d 241, 247 (3d Cir.2004) (quoting Anderson, 477 U.S. at 255, 106 S.Ct. 2505).

*494 “[T]he party moving for summary judgment under Fed.R.Civ.P. 56(c) bears the burden of demonstrating the absence of any genuine issues of material fact.” Aman v. Cort Furniture Rental Corp., 85 F.3d 1074, 1080 (3d Cir.1996).

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Bluebook (online)
669 F. Supp. 2d 490, 2009 U.S. Dist. LEXIS 100490, 2009 WL 3584342, Counsel Stack Legal Research, https://law.counselstack.com/opinion/handron-v-sebelius-njd-2009.