Tarbert v. Azar

District Court, D. Montana·Decided May 12, 2020·No. 9:19-cv-00149·Unknown

Opinion

FILE IN THE UNITED STATES DISTRICT COURT □ FOR THE DISTRICT OF MONTANA MAY 1 2 2020 MISSOULA DIVISION Clerk, U.S. District Court District Of Montana Kiezoula KELLY TARBERT, CV 19-149-M-—DLC Plaintiff, vs. ORDER ALEX AZAR, Secretary, U.S. Department of Health & Human Services, Defendant. Tarbert requests attorney’s fees under the Equal Access to Justice Act (“EAJA”) for the work performed by her attorney, Allan McGarvey, in challenging the Medicare Appeals Council’s (“the Council”) decision denying her relief. (Docs. 30, 31.) For the reasons explained, the motion is granted in part. Background In 1997, Kelly Tarbert moved to Libby, Montana where she was exposed to asbestos dust from a local mining operation and eventually developed respiratory problems. (Doc. 28 at 3.) In 2011, Tarbert obtained a $51,908.00 settlement for her asbestos-related injuries. (/d.) Under Medicare’s secondary payer statute, Medicare then sought reimbursement for medical bills that were subsequently compensated by her settlement. (/d. at 3-4.) After considerable back and forth with the agency, in October of 2012, Medicare produced a final bill of payments

for which it sought reimbursement. (/d. at 3—5.) However, Tarbert still disputed some of the charges on her final bill. Wd.) Specifically, she disputed any charge that occurred within ten years of her initial exposure as asbestos related injuries

_ have a minimum ten-year latency period. (/d. at6.) Tarbert sought review of her case before an administrative law judge (“ALJ”). (Ud. at 7.) At the hearing, McGarvey informed the ALJ that Tarbert was only challenging the charges that were circled on the billing form. (/d. at 8.) When the ALJ issued his written decision, he looked to the only place in the record that contained circled charges—an outdated billing form that Tarbert had submitted earlier in the dispute resolution process.! (Jd. at 12.) The ALJ then issued a “fully favorable” decision, however, his reliance on the outdated form resulted in a reduction of only $208.03 instead of Tarbert’s requested $1,782.31. (See id. at 7-9). Tarbert then appealed to the Council. (/d.) Attached to her appeal, Tarbert submitted the July 2012 form on which she circled a different set of disputed charges. (/d. at 9.) Because Tarbert did not use Medicare’s current billing statement from October 2012, it appeared as though she was disputing only some of the latency period charges. (Jd.) To indicate the total in dispute, Tarbert

' The outdated billing form was from April 2012, whereas Medicare’s final billing form was issued in October 2012.

separately submitted an adding tape that corresponded to the circled charges on the July 2012 form, but did not instruct the agency to disregard the circled charges on the April 2012 form or otherwise explain the ALJ’s confusion. (Jd.) The Council adopted the ALJ’s decision after determining that Tarbert still had not clearly identified the disputed charges. (/d.) Tarbert appealed to this Court. (Doc. 1.) The Court remanded upon finding that the Council’s decision was not supported by substantial evidence because Tarbert’s identification of the disputed charges was reasonably clear once the records submitted by Tarbert were compared side by side. (Doc. 28 at 12-13.) Tarbert now requests attorney’s fees for McGarvey’s time seeking this Court’s review. Discussion To award attorney’s fees under the EAJA, a court must determine that “(1) the plaintiff is the prevailing party; (2) the government has not met its burden of showing that its positions were substantially justified or that special circumstances make an award unjust; and (3) the requested attorney’s fees and costs are reasonable.” Perez—Arellano v. Smith, 279 F.3d 791, 793 (9th Cir. 2002); 28 U.S.C. § 2412(d)(1)(B). A court’s award of fees is subject to its discretion. Flores v. Shalala, 49 F.3d 562, 567 (9th Cir. 1995).

I. Whether Tarbert is the prevailing party. A party is a prevailing party when she “succeed[s] on any significant issue in litigation which achieves some of the benefit [she] sought in bringing suit.” Farrar v. Hobby, 506 U.S. 103, 109 (1992). Here, Tarbert succeeded on a significant issue when the Court determined that the “Council’s decision to adopt the ALJ’s findings is not supported by substantial evidence” and remanded to the

agency to remove the latency period charges. (Doc. 28 at 14.) Accordingly, Tarbert is the prevailing party. The Government does not argue otherwise. II. Whether the Government’s position is substantially justified. The government’s position is substantially justified when it is “justified to a degree that could satisfy a reasonable person.” Decker v. Berryhill, 856 F.3d 659, 664 (9th Cir. 2017) (quoting Pierce v. Underwood, 487 U.S. 552, 565 (1988)). In other words, “substantial justification is equated with reasonableness.” Thangaraja v. Gonzales, 428 F.3d 870, 874 (9th Cir. 2005). The government’s position is reasonable when it is supported in law and fact. Jd. The government bears the burden to justify both “the original agency action and its litigation position.” League of Wilderness Defs./Blue Mountains Biodiversity Project v. U.S. Forest Serv., No. 3:10-CV-01397-SI, 2014 WL 3546858, at *1 (D. Or. July 15, 2014) (citing Gutierrez v. Barnhart, 274 F.3d 1255, 1258 (9th Cir. 2001)). That said, a court’s determination that the agency’s position was not supported by

substantial evidence is a “strong indication” that the government’s position was not substantially justified. Thangaraja, 428 F.3d at 874. In its cross motion for summary judgment, the Government primarily argued that the Council’s decision should be upheld because Tarbert’s request was not clearly articulated. (See Doc. 20 at 18-20.) Specifically, the Government argued that Tarbert failed to explain why she disputed some, but not all, of the pre-2007 charges. (/d.) The Government also observed that to the extent there was any mistake in the agency’s ruling, the mistake was due to the agency’s reasonable reliance on Tarbert’s instruction that she was only challenging the circled charges. (Id. at 19.) While both contentions may be true, neither argument is directly responsive to whether the Council’s decision was supported by substantial evidence. The Council denied Tarbert relief because it believed that Tarbert had not specifically identified the disputed charges. (Doc. 28 at 9-10.) But the Council was wrong. Tarbert’s documentation on appeal provided enough information that the agency ought to have been able to discern the disputed charges. The Government has not met its burden to show that the Council’s decision was supported by substantial evidence and its litigation position was not substantially justified. Tarbert is therefore entitled to fees, assuming her request is reasonable.

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