MacHado v. Leavitt

542 F. Supp. 2d 185, 2008 U.S. Dist. LEXIS 29035, 2008 WL 961323
CourtDistrict Court, D. Massachusetts
DecidedApril 9, 2008
DocketCivil Action 07-30111-MAP
StatusPublished
Cited by5 cases

This text of 542 F. Supp. 2d 185 (MacHado v. Leavitt) is published on Counsel Stack Legal Research, covering District Court, D. Massachusetts primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
MacHado v. Leavitt, 542 F. Supp. 2d 185, 2008 U.S. Dist. LEXIS 29035, 2008 WL 961323 (D. Mass. 2008).

Opinion

MEMORANDUM AND ORDER REGARDING PLAINTIFFS’ MOTION TO CERTIFY CLASS AND DEFENDANTS’ MOTION TO DISMISS (Dkt. Nos. 2 & 27)

PONSOR, District Judge.

I. INTRODUCTION

Phrased generally, this lawsuit raises the following question: how egregious does an agency’s failure to make timely corrections of its own mistakes have to be, and how much suffering do these uncorrected errors have to inflict, before a violation of due process may be found? Specifically, these low-income Plaintiffs contend they have suffered erroneous and excessive deductions from their monthly Social Security checks as a result of blunders by Defendants in the calculation of their prescription drug plan premiums under Medicare Part D. These mistakes, *188 which at this point are undisputed, have deprived Plaintiffs of hundreds of dollars for periods lasting from five to seventeen months. They seek a remedy in the form of declarative and injunctive relief requiring Defendants, the Department of Health and Human Services (“HHS”) and the Social Security Administration (“SSA”), to adopt procedures that will insure that these harmful errors occur less often and, when they do occur, are corrected more promptly.

In Count I, Plaintiffs charge the two agencies with failing to comply with 42 U.S.C. §§ 1395w-24(d)(2)-(4) and 42 U.S.C. § 1395w-113(c)(l), provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, 42 U.S.C. §§ 1395w-101 et seq. (“MMA”), mandating that HHS provide the SSA with accurate information about the monthly premiums to be deducted from Part D enrollees’ Social Security benefits “by the beginning of each year” and that HHS properly update that information “periodically throughout the year.” Counts II and III charge Defendants with, in effect, withholding and retaining Plaintiffs’ Social Security benefits without authorization in contravention of 42 U.S.C. § 407(a), which prohibits the transfer or assignment of any Social Security recipient’s right to benefits. In Count IV, Plaintiffs allege that Defendants have denied them due process, in violation of the Fifth Amendment, by negligently withholding incorrect and excessive premium amounts from their Social Security checks and refunding those improperly withheld sums only after unreasonable delay. Plaintiffs also seek certification of a national class encompassing all Medicare recipients who have suffered similar erroneous reductions of their Social Security benefits due to Defendants’ errors, and they request appointment of class counsel. (Dkt. No. 2.)

Defendants moved to dismiss Plaintiffs’ claims for lack of subject matter jurisdiction under Fed.R.Civ.P. 12(b)(1) and for failure to state a claim under Fed.R.Civ.P. 12(b)(6). (Dkt. No. 27.) On March 31, 2008, the court denied Plaintiffs’ motion to certify and appoint counsel, without prejudice, and allowed Defendants’ motion to dismiss as to Plaintiffs’ statutory claims (Counts I through III) but denied it as to the due process. claim (Count IV)- This memorandum will spell out the court’s rationale in more detail.

II. FACTS 1

A. Medicare Part D.

Plaintiffs Sybil Machado, Bennett Gordon, Mary Morgan, Janet Straczek, Carol Trisciuzzi, Inez Choma, William Choma, Kathleen Smith, Janis M. Watts, Phyllis Fagan, Ida Stefanou, Theodore Leender, and Mary-Lou Leender are all Medicare recipients who participate in the Medicare Part D program, which provides them with prescription drug benefits through private insurance plans. The Medicare Part D program went into effect on January 1, 2006. It is a substantial program, with millions of enrollees nationwide.

Participants in Part D may choose from among several benefit packages and providers. Generally, all enrollees must pay *189 monthly premiums to the provider offering whichever plan they select. They have several options as to how to make their payments, including paying directly or asking that the premiums be withheld from their Social Security benefits and then remitted to the provider by the SSA. Approximately five million Part D participants have chosen to have their premiums taken directly out of their Social Security benefits.

The option of paying premiums through Social Security withholding requires communication regarding the correct premium amounts between the SSA and the Centers for Medicare & Medicaid Services (“CMS”), the specific unit of HHS that administers Medicare, since the two entities operate separate computer systems. Given this need for communication, the statutory provisions enacting Part D direct the Secretary of HHS to transmit to the SSA:

by the beginning of each year, the name, social security account number, [and] consolidated monthly beneficiary premium ... owed by such enrollee for each month during the year, and other information determined appropriate by the Secretary, in consultation with the Commissioner of Social Security....

42 U.S.C. § 1395w-24(d)(3). Additionally, HHS is required to update this information “periodically throughout the year” by means of supplemental communications with the SSA, Id.

B. Plaintiffs.

Plaintiffs are all enrollees in Medicare Part D. Though their experiences with the program have varied, all of them have had difficulty straightening out errors as to the correct source and amount of the payment for their Part D premiums. Plaintiffs have undisputedly endured months of futile, and no doubt maddening, attempts to remedy improper withholdings — contacting the SSA, CMS, and their plan providers on numerous occasions only to be met with disclaimers of responsibility or false reassurances that the problem would soon be corrected. For most of them, Social Security benefits are their only source of income and the amounts erroneously withheld from those funds represent a significant deprivation and cause substantial hardship.

Plaintiffs’ problems with Part D fall into several categories.

1. Subsidized Premiums.

Sybil Machado’s monthly Part D premium of $16.90 is paid through a Massachusetts low-income assistance program. Though Machado never requested that her premiums be withheld from her Social Security benefit checks, the SSA began doing so in March 2007. Machado contacted her insurance provider, the SSA, and CMS several times to request a correction of the problem.

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

Related

Bond v. Azar
D. Arizona, 2020
Windstead v. District of Columbia
840 F. Supp. 2d 149 (District of Columbia, 2012)
Lightfoot v. District of Columbia
273 F.R.D. 314 (District of Columbia, 2011)
Winstead v. District of Columbia
620 F. Supp. 2d 119 (District of Columbia, 2009)

Cite This Page — Counsel Stack

Bluebook (online)
542 F. Supp. 2d 185, 2008 U.S. Dist. LEXIS 29035, 2008 WL 961323, Counsel Stack Legal Research, https://law.counselstack.com/opinion/machado-v-leavitt-mad-2008.