Situ v. Leavitt

240 F.R.D. 551, 2007 U.S. Dist. LEXIS 5903, 2007 WL 127993
CourtDistrict Court, N.D. California
DecidedJanuary 12, 2007
DocketNo. C06-2841 TEH
StatusPublished
Cited by2 cases

This text of 240 F.R.D. 551 (Situ v. Leavitt) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Situ v. Leavitt, 240 F.R.D. 551, 2007 U.S. Dist. LEXIS 5903, 2007 WL 127993 (N.D. Cal. 2007).

Opinion

ORDER GRANTING IN PART PLAINTIFFS’ MOTION FOR CLASS CERTIFICATION

THELTON E. HENDERSON, District Judge.

This matter came before the Court on Monday, October 23, 2006, on Defendant’s motion to dismiss and Plaintiffs’ motion for class certification. The Court granted in part and denied in part Defendant’s motion to dismiss on December 18, 2006. Now, after carefully considering the parties’ written and oral arguments, the record, and governing law, the Court GRANTS IN PART Plaintiffs’ motion for class certification. The Court finds class certification to be appropriate but modifies Plaintiffs’ proposed class definition for the reasons discussed below.

BACKGROUND

Plaintiffs’ class action complaint arises out of the Medicare Part D prescription drug program created by Title I of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (“MMA”). Prior to 2006, Medicare beneficiaries who were also eligible for Medicaid received their prescription drug coverage from their states’ Medicaid agencies. However, prescription drug coverage for these individuals, known as “dual eligibles,” ended under Medicaid on December 31, 2005. As of January 1, 2006, prescription coverage for dual eligibles was shifted from Medicaid to the Medicare Part D program.

Defendant Michael O. Leavitt, the Secretary of the United States Department of Health and Human Services (“HHS”), is responsible for the conduct and policies of HHS, including the Centers for Medicare and Medicaid Services (“CMS”), which administers the Medicare program. Defendant is thus responsible for implementing the changes in prescription drug coverage for dual eligibles under the MMA.

The second amended complaint names thirteen individual plaintiffs seeking to represent the following class: “All full benefit dually eligible Medicare beneficiaries who are unable to receive the full benefits of Medicare Part D prescription drug coverage and/or the Low Income Subsidy program due to the actions or failure to act of the Secretary of Health and Human Services.” Second Am. Compl. 1149 (hereinafter “SAC”). Four organizations are also named as plaintiffs based on allegations that they have had to divert resources to counsel their clients and members on changes in them prescription drug coverage following enactment of the MMA.

[555]*555Plaintiffs raise three challenges to the provision of Part D benefits to dual eligibles. First, Plaintiffs allege that Defendant has failed to implement “uniformly and properly” the requirement that dual eligibles be auto-enrolled into a private prescription drug plan if they do not enroll in a plan of their own choice, and that therefore many dual eligibles have not been enrolled in a Part D prescription drug plan. Id. H 3. Second, Plaintiffs allege that Defendant has failed to inform Part D plans on a timely basis of the identity of dual eligibles automatically enrolled in their respective plans and of the beneficiaries’ entitlement to the Low Income Subsidy (“LIS”), a program established by the MMA to waive the monthly Part D plan premium and annual deductible and to reduce cost sharing by the beneficiary. Id. Finally, Plaintiffs allege that Defendant has failed to process changes in plan enrollment “adequately and uniformly” when dual eligibles decide to change prescription drug plans. Id.

On December 18, 2006, the Court dismissed one individual plaintiff without prejudice based on Plaintiffs’ counsel’s representation that she was no longer able to participate in this lawsuit. The Court also dismissed all four organizational plaintiffs, although dismissal of two of these four plaintiffs was with leave to amend. In addition, the Court ordered Plaintiffs to show cause as to why the Court should not dismiss four other individual plaintiffs — two who appear to be deceased and two whom Plaintiffs’ counsel have been unable to contact. Plaintiffs have until January 16, 2007, to file a response to that order to show cause, but the Court need not determine whether those individuals should remain in this case before deciding the pending motion for class certification because their presence or absence does not affect the Court’s analysis of relevant issues.

DISCUSSION

I. Jurisdiction over Claims of Unnamed Class Members

Defendant first argues that class certification would be improper because this Court lacks jurisdiction over claims brought by unnamed class members. Plaintiffs assert three grounds for jurisdiction, each of which the Court discusses in turn below.

A. 42 U.S.C. § 405(g)

As explained in the Court’s order on Defendant’s motion to dismiss, the parties agree that 42 U.S.C. § 405(g) provides jurisdiction over Plaintiffs’ claims if Plaintiffs have satisfied both the presentment and exhaustion requirements — i.e., if they have presented a claim for benefits to the Secretary and have fully pursued all available administrative remedies. Mathews v. Eldridge, 424 U.S. 319, 328, 96 S.Ct. 893, 47 L.Ed.2d 18 (1976). This holds true for unnamed class members as well as for named class representatives. Califano v. Yamasaki, 442 U.S. 682, 701, 99 S.Ct. 2545, 61 L.Ed.2d 176 (1979); Weinberger v. Salfi, 422 U.S. 749, 764, 95 S.Ct. 2457, 45 L.Ed.2d 522 (1975). The presentment requirement is nonwaivable, but the exhaustion requirement may be waived. Eldridge, 424 U.S. at 328, 96 S.Ct. 893. In this case, Plaintiffs argue that class members satisfied the presentment requirement by making initial claims for benefits and that the exhaustion requirement should be waived.

1. Presentment

This Court has already ruled that the presentment requirement should be interpreted liberally, and it is therefore sufficient for a plaintiff to have made a phone call to or otherwise contacted CMS with a complaint, or to have complained to the relevant Part D plan or, in the case of individuals contesting liability for the LIS, the appropriate state Medicaid office. Order Granting in Part & Denying in Part Def.’s Mot. to Dismiss at 19-20. However, Plaintiffs propose to include in the class individuals who did not make even these minimal contacts, and the Court must therefore now decide whether, as Plaintiffs argue, a plaintiff satisfies the presentment requirement by making an initial claim for benefits without also raising a complaint regarding the inability to obtain specific benefits under Part D.

To support their argument, Plaintiffs rely on the Ninth Circuit’s decision in Briggs v. Sullivan, 886 F.2d 1132 (9th Cir.1989). [556]*556The Briggs plaintiffs were individuals who had been determined eligible for disability benefits but who were not being paid such benefits because they were without a representative payee.

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Related

Davis v. Astrue
250 F.R.D. 476 (N.D. California, 2008)
MacHado v. Leavitt
542 F. Supp. 2d 185 (D. Massachusetts, 2008)

Cite This Page — Counsel Stack

Bluebook (online)
240 F.R.D. 551, 2007 U.S. Dist. LEXIS 5903, 2007 WL 127993, Counsel Stack Legal Research, https://law.counselstack.com/opinion/situ-v-leavitt-cand-2007.