Sexton v. SSA

CourtDistrict Court, E.D. Kentucky
DecidedMay 31, 2022
Docket6:21-cv-00187
StatusUnknown

This text of Sexton v. SSA (Sexton v. SSA) 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
Sexton v. SSA, (E.D. Ky. 2022).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF KENTUCKY SOUTHERN DIVISION (at London)

MARY ELIZABETH SEXTON, et al., ) ) Plaintiffs, ) Civil Action No. 6:21–CV–187–CHB ) v. ) ) MEMORANDUM AND OPINION ) KILOLO KIJAKAZI, ) COMMISSIONER OF SSA, ) ) Defendant. ) *** *** *** *** This matter is before the Court on the Motion to Dismiss Plaintiffs’ Complaint for Failure to State a Claim filed by Defendant Kilolo Kijakazi, Commissioner of the Social Security Administration (“SSA”). [R. 16]. Plaintiffs responded to the Motion, [R. 18], and the Commissioner replied, [R. 20]. This matter is fully briefed. For the reasons set forth herein, the Court will grant the Commissioner’s Motion to Dismiss. I. Background Around 2006, the SSA was alerted to “possible wrongdoing” involving Kentucky attorney Eric C. Conn, SSA Administrative Law Judges (“ALJs”), and four physicians. Hicks v. Comm’r of Soc. Sec., 909 F.3d 786, 793 (6th Cir. 2018); see also [R. 18, pp. 3–4]. Upon investigation, the “possible wrongdoing” was confirmed to be a widespread fraudulent scheme in which Conn secured Supplemental Security Income benefits and Social Security Disability Insurance for his clients based on fraudulent disability applications. [R. 16, p. 3 n.3]; Hicks, 909 F.3d at 793. As summarized by the Sixth Circuit, the scheme worked as follows: Conn created a limited number of template Residual Functional Capacity ("RFC") forms, which he or attorneys in his office filled out ahead of time. Id. at 13. These forms, which are normally meant to convey a claimant's "ability to do work-related activities on a day-to-day basis in a regular work setting," 16-cv-154 (Hicks), R. 42-2 (Adkins Report, RFC Form) (Page ID #1438), were purportedly manipulated to ensure that they satisfied the SSA's criteria for establishing a disability. Id. The doctors above then signed these forms without making any adjustments, and Conn submitted the forms to the SSA on behalf of his clients. Id. [ALJ] Daugherty, who was allegedly receiving bribes from Conn, then assigned Conn's cases to himself and issued favorable rulings to Conn's clients. Id. at 14-15; Pls. Br. at 4.

Hicks, 909 F.3d at 793. In 2011, to cover his criminal behavior, Conn had thousands of pounds of documents from the Conn Law Firm shredded, including medical records for disability claims. Id.; see also [R. 1, p. 7, ¶ 18]. Nonetheless, by 2014, the SSA’s Office of the Inspector General (“OIG”) had identified over a thousand individuals––all of whom had been represented by Conn––whose applications, the OIG “‘had reason to believe,’ were tainted by fraud.” Hicks, 909 F.3d at 794. Due to the suspected fraud, the SSA initiated redetermination hearings to reevaluate the flagged individuals’ eligibility for benefits. Id. Such redetermination hearings were in accordance with the Social Security Act (“the Act”), which requires the SSA to “immediately redetermine” a beneficiary’s entitlement to disability benefits if, at any point after granting benefits, the SSA has “reason to believe that fraud or similar fault was involved in the application” for benefits. See 42 U.S.C. § 405(u)(1)(A). In 2020–2021, the SSA informed Plaintiffs Mary Elizabeth Sexton, Rose Ann Slone, Delmer Gene Reynolds, and Jeffrey Neal Bentley that redetermination hearings were required in their cases, as Conn represented all of them when they obtained disability benefits (anywhere from 2005–2010). [R. 1, pp. 3–5, ¶¶ 5–9]; see also 42 U.S.C. § 405(u)(1)(A); [R. 1–4 (SSA letters advising Plaintiffs on how to prepare for their hearings)].1 To prevent the redetermination hearings, Plaintiffs collectively filed a Complaint and Petition for Injunctive Relief (“Complaint”) in this Court. [R. 1]. Specifically, the Plaintiffs seek (1) a declaratory judgment and injunctive relief that prohibits the Commissioner from initiating the redetermination hearings, and (2) a finding

that the Commissioner has violated the due process clause of the Constitution and the “immediately” requirement of 42 U.S.C. § 405(u)(1)(A) since the redetermination hearings are to occur “over a decade after [the Commissioner] received notice of the fraud[.]” Id. at 9 ¶¶ 24, 26. In response, the Commissioner moves to dismiss the Plaintiffs’ claims for, among other things, lack of jurisdiction. See [R. 16].2 Plaintiffs responded, [R. 18], and the Commissioner replied, [R. 20]. II. Standard of Review A motion under Federal Rule of Civil Procedure 12(b)(1) asserts that the court lacks subject matter jurisdiction. Motions to dismiss for lack of subject matter jurisdiction fall into two categories: facial attacks and factual attacks. United States v. Richie, 15 F.3d 592, 598 (6th Cir.

1994). A facial attack is a challenge to the sufficiency of the pleading itself. Id. “On such a motion, the court must take the material allegations of the petition as true and construed in the light most favorable to the nonmoving party.” Id. (citing Scheuer v. Rhodes, 416 U.S. 232, 235–

1 Plaintiff Mary Elizabeth Sexton has already been subjected to one redetermination hearing, which resulted in the termination of her benefits. [R. 16, p. 2]. However, after the Sixth Circuit’s ruling in Hicks, the District Court remanded Sexton’s case for further proceedings consistent with the Hicks ruling and reinstated her benefits until the redetermination proceedings were completed. See [R. 16, pp. 4–5]; In re Various Soc. Sec. Cases Affected by the Sixth Circuit Decision, No. 17–5206, 2019 U.S. Dist. LEXIS 116439 (E.D. Ky. July 12, 2019) (Case No. 7:16–CV– 212). Accordingly, the SSA is currently trying to conduct another redetermination hearing in Sexton’s case that is consistent with the Hicks opinion. Id. Thus, if the Court were to halt the redetermination hearing in Sexton’s case, it would effectively overturn the District Court’s previous remand order, and the Sixth Circuit’s ruling in Hicks. As a result, and in addition to the other reasons provided in this opinion, the Court declines to stop Sexton’s redetermination hearing. 2 Because the Court is granting the Commissioner’s Motion to Dismiss [R. 16] under Rule 12(b)(1) for lack of jurisdiction, it will not address the Commissioner’s alternative argument to dismiss the Complaint under Rule 12(b)(6) for failure to state a claim. See [R. 16, pp. 16–17; R. 20, pp. 7–8]. 37 (1974)). If those allegations establish federal claims, jurisdiction exists. Gentek Bldg. v. Sherwin-Williams Co., 491 F.3d 320, 330 (6th Cir. 2007). A factual attack is not a challenge to the sufficiency of the pleading’s allegations, but a challenge to the factual existence of subject matter jurisdiction. Richie, 15 F.3d at 598. With a factual attack, “no presumptive truthfulness

applies to the factual allegations” and “the court is free to weigh the evidence and satisfy itself as to the existence of its power to hear the case.” Id. In its review, the district court has wide discretion to allow affidavits, documents, and even a limited evidentiary hearing to resolve jurisdictional facts. Gentek, 491 F.3d at 330 (citations omitted).

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