Perkins v. Colvin

224 F. Supp. 3d 575, 2016 U.S. Dist. LEXIS 173974, 2016 WL 7332989
CourtDistrict Court, E.D. Kentucky
DecidedDecember 16, 2016
DocketCivil Case No. 16-cv-35-JMH
StatusPublished
Cited by36 cases

This text of 224 F. Supp. 3d 575 (Perkins v. Colvin) is published on Counsel Stack Legal Research, covering District Court, E.D. Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Perkins v. Colvin, 224 F. Supp. 3d 575, 2016 U.S. Dist. LEXIS 173974, 2016 WL 7332989 (E.D. Ky. 2016).

Opinion

MEMORANDUM OPINION & ORDER

Joseph M. Hood, Senior United States District Judge

This matter is before the Court upon the Acting Commissioner’s Motion to Dismiss [DE 30] Counts I, II, III, IV, V and VI of Plaintiffs Amended Complaint pursuant to Fed. R. Civ. P. 12(b)(6) for failure to state a claim. Plaintiff has filed a Response [DE 42], stating his objections to the Motion, and the Acting Commissioner has filed a Reply [DE 44] in further support of her Motion. The Court provided notice to the parties that this Motion would be converted to motions for summary judgment in part and provided the parties time to respond [DE 48 and 50]. In the absence of any objections to that transformation, the matter is now ripe for review. Because there are no disputes regarding the material facts, and because resolution of the legal issues favor the defendant, for all of the reasons stated below, the Acting Commissioner’s Motion will be granted.

As the Court has previously recounted in its decision on Plaintiffs Motion for Preliminary Injunction [DE 46], Plaintiff Perkins resides in Pike County, Kentucky. On September 27, 2006, Plaintiff filed applications for benefits under Title II (disability) and Title XVI (supplemental security income or “SSI”) of the Social Security Act, claiming disability since September 30, 2005, as a result of Meni-ere’s disease, a disorder of the inner ear causing such symptoms as vertigo, pain, [577]*577and hearing loss. After his claims were initially denied, Perkins obtained the assistance of attorney Eric C. Conn in prosecuting his application. Perkins submitted new evidence and requested a hearing. No hearing was held, but, on July 6, 2007, his application was approved in a fully-favorable, on-the-record decision by Administrative Law Judge David B. Daugherty. Daugherty found that Perkins had been disabled since September 30, 2005, based in part on the examination and report of Dr. Frederic Huffnagle, who is now deceased. In 2011, Perkins underwent a continuing disability review by another physician who concluded that he was still disabled. [See DE 13-1, PageID # 95.]

Conn, Huffnagle, and Daugherty have since been implicated in a scheme to defraud the Social Security Administration, which scheme is the basis for the present controversy. Specifically, the Social Security Administration Office of the Inspector General had discovered reason to believe that Conn or his firm submitted pre-com-pleted “template” residual functional capacity forms purportedly from Bradley Adkins, Ph.D., Srinivas Ammisetty, M.D., David P. Herr, D.O., or Huffnagle, dated between January 2007 and May 2011, in support of the individuals’ applications for benefits. In an indictment concerning this scheme, the United States alleges that Dáugherty assigned Conn’s cases to himself and solicited falsified medical evidence from Conn so that he could issue favorable on-the-record decisions without hearings.1 For his part, Conn allegedly provided pre-completed template residual functional capacity reports to doctors, including Huff-nagle, who signed them without amendment. After an award of benefits to his client, the United States alleges that Conn received fees from the Social Security Administration and withdrew cash from business account to make payments to Daugherty.

This scheme was the subject of an investigation by the Social Security Administration’s Office of the Inspector General (“OIG”), which spanned the years from 2007 to 2015. The OIG sent notice to the Commissioner on July 2, 2014, pursuant to 42 U.S.C. § 1320a-8(1), advising that it had reason to believe fraud was involved in 1,787 applications, all involving Conn. The initial referral was made with no adverse action to be taken against the applicants until' further notice. Further notice came on May 12, 2015, when the OIG notified the Commissioner that it had no objections to the agency “moving forward with its administrative processing of the redeter-minations of the 1,787 individuals whose names were previously provided by OIG to [the agency] on July 2, 2014.” Via letters sent six days later and captioned “Notice of Appeals Council Action,” the Commissioner informed those individuals, including Perkins, that the agency was required to redetermine their benefits under sections 205(u) and 1631(e)(7) of the Act, 42 U.S.C. §§ 405(u), 1383(e)(7), in light of the OIG’s notification.2

[578]*578Perkins’s case was then remanded to a new ALJ for a new hearing, and he was permitted to submit further evidence to the ALJ prior to the new hearing, Perkins attended his new hearing on November 15, 2015, with counsel and cobbled together some medical records, mostly for the period after July 6, 2007. On December 29, 2015, disregarding Dr. Huffnagle’s report and the continuing disability review, the ALJ found that there was insufficient evidence to support the initial disability determination. Perkins then submitted his case to the Appeals Council, which declined to reconsider the ALJ’s decision on January 28, 2016. The denial constitutes final agency action, and Perkins timely filed this action as provided for by 42 U.S.C. § 405(g) on March 25, 2016.

In his Complaint, Plaintiff challenged the merits of the ALJ’s decision and asked that the decision “be vacated for failure to bring a timely action and violating Plaintiffs due process rights.” [DE 1 at PageID # 3.] The Court has already denied Plaintiffs Motion for Preliminary Injunction, and now considers the Acting Commissioner’s request for dispositive relief on the undisputed facts. The Acting Commissioner argues that Perkins cannot demonstrate, as a matter of law, that he was denied the process that he was due under the Fifth Amendment to the United States Constitution by the Acting Commissioner when his matter was subjected to determination in spite of the fact that the Acting Commissioner has never disclosed what evidence proves that there was, in fact, reason to believe that fraud was involved in the original award of benefits to him in 2007 and notwithstanding the fact that he has not had an opportunity to challenge the credibility of this evidence. Plaintiff argues, however, that he was not provided the required opportunity to challenge the allegations of fraud as a matter of law because the Appeals Council’s May 18, 2015 notice which commenced his redeter-mination process “summarily accepted the allegation that ‘there was reason to believe fraud was involved.’ ” [DE 13-1, PageID # 95.] He argues that, while he has no right to a full evidentiary hearing before the termination of benefits under Mathews v. Eldridge, 424 U.S. 319, 96 S.Ct. 893, 47 L.Ed.2d 18 (1976), he should have an opportunity to challenge the conclusion that there was reason to believe that fraud was involved in obtaining his initial award of benefits.

The Acting Commissioner argues, as well, that Plaintiff cannot demonstrate, as a matter of law, that the agency’s procedures constituted a violation of the Administrative Procedures Act (“APA”), 5 U.S.C. § 556(d)-(e), and the Social Security Act, 42 U.S.C.

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Cite This Page — Counsel Stack

Bluebook (online)
224 F. Supp. 3d 575, 2016 U.S. Dist. LEXIS 173974, 2016 WL 7332989, Counsel Stack Legal Research, https://law.counselstack.com/opinion/perkins-v-colvin-kyed-2016.