Walters v. Leavitt

376 F. Supp. 2d 746, 2005 U.S. Dist. LEXIS 14224, 2005 WL 1661074
CourtDistrict Court, E.D. Michigan
DecidedJuly 14, 2005
Docket05-CV-70888-DT
StatusPublished
Cited by12 cases

This text of 376 F. Supp. 2d 746 (Walters v. Leavitt) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Walters v. Leavitt, 376 F. Supp. 2d 746, 2005 U.S. Dist. LEXIS 14224, 2005 WL 1661074 (E.D. Mich. 2005).

Opinion

ORDER GRANTING DEFENDANT’S “MOTION TO DISMISS”

CLELAND, District Judge.

Plaintiffs filed this civil action against Defendant Michael O. Leavitt, the acting Secretary of the Department of Health & Human Services, in his individual and his official capacity. Plaintiffs assert subject matter jurisdiction pursuant to 28 U.S.C. § 1331, averring that this case presents questions “aris[ing] under.Title XVIII of the Social Security Act of 1935, Public Law No. 74-271 (49 Stat. 620), being 42 U.S.C. § 1395, et seq., as amended” and under certain Medicare regulations, specifically 42 C.F.R. § 411.37. (Pis.’ Compl. at ¶2.)

*749 Plaintiffs seek four forms of declaratory or equitable relief against Defendant: (1) a declaratory judgment determining the rights of the parties under certain provisions of the Medicare Act’s Secondary Payer (“MSP”) provisions, see 42 U.S.C. § 1395y(b); (2) a preliminary and permanent injunction compelling Defendant Secretary to produce information, including an itemized list of federal Medicare benefits paid to, or on behalf of, Plaintiffs, including the amount of reimbursement that Defendant will seek; (3) a preliminary and permanent injunction compelling Defendant to “declare upon what terms a Medicare Set Aside Trust Account for the Plaintiffs shall be deemed sufficient for Defendant’s purposes,” appointing a trustee for the set aside account, and setting forth a method and procedure for administering the set aside trust account (related to future claims of reimbursement); and (4) an order awarding Plaintiffs their costs and attorney fees. (Id. at 6.)

On May 11, 2005, Defendant filed its “Motion to Dismiss” for lack of subject matter jurisdiction pursuant to Federal Rule of Civil Procedure 12(b)(1). Defendant argues that the court’s jurisdiction to review Plaintiffs’ claims is governed exclusively by 42 U.S.C. § 405(h), which provides that: “No action against the United States, the [Secretary] or any officer or employee thereof shall be brought under section 1331 or 1346 of Title 28 to recover on any claim arising under this subchap-ter.” 42 U.S.C. § 405(h). Defendant maintains that because Plaintiffs have neglected to allege jurisdiction under § 405(h) and because they admittedly have failed to exhaust statutorily required administrative remedies required by § 405(h), the court lacks subject matter jurisdiction.

Plaintiffs filed their response on June 6, 2005, arguing that exhaustion or “administrative channeling” does not apply in this case and federal question subject matter jurisdiction is proper under 28 U.S.C. § 1331. Defendant filed a reply on June 16, 2005, and the court held oral argument on July 6, 2005. For the reasons set forth below, the court will grant Defendant’s motion and dismiss Plaintiffs’ claims without prejudice.

I. BACKGROUND

A. Factual Background

Plaintiff Terrance L. Walters was severely injured in November 1997 during an accident at a construction site in Monroe County, Michigan. According to Plaintiffs, a crane operator negligently operated an overhead traveling bridge crane, causing the crane’s load line to part. When the. load line parted, a several hundred pound block fell to the ground below, injuring Mr. Walters. (Pis.’ Compl. at ¶¶ 6-7.) As a result of this accident, Walters sustained a severe head injury and was rendered a quadriplegic. (Id. at ¶ 7.)

After determining that Walters was permanently and totally disabled from gainful employment under Michigan’s Workers’ Disability Compensation Act of 1969, Mich. Comp. Laws § 418.101,. et seq., Liberty Mutual Insurance Company began paying statutory benefits. (Id. at ¶ 8.) Plaintiff also received additional statutory benefits from Michigan’s “Second Injury Fund.” These benefits are paid and administered by the State of Michigan. See Mich. Comp. Laws § 418.501(1), et seq. (Id. at ¶ 9.)

Plaintiffs also allege that Mr. Walters was determined to be totally and permanently disabled, becoming eligible for additional benefits under the Social Security Administration and becoming a Medicare recipient, under Title XVIII of the Social Security Act. (Id. at ¶ 10.) Plaintiffs claim that Walters sought medical care that was *750 conditionally paid for, in whole or at least in part, by Medicare. (See id. at ¶¶ 7, 10, 15.) The parties do not dispute that some federal benefits were paid by Medicare, and Defendant is named as the individual responsible for the administration and control of these federal benefits that have been, or will be, received in the future.

In December 1997, Plaintiffs, acting pursuant to Mich. Comp. Laws § 418.827(1), filed a civil tort action against certain identified third-party tortfeasors in Monroe County Circuit'Court. See Walters v. Bascon Inc., et al., Case No. 97-7441-NO (Dec. 23, 1997). Plaintiffs allege that they have conducted discovery, litigated pretrial claims and defenses, prosecuted liability in preparation for trial, and'are close to negotiating a settlement in the state court action.

The rub or impediment, however; comes with regard to certain liens asserted against any proceeds recovered by Plaintiffs in the state court lawsuit, specifically a subrogation lien against settlement proceeds that • arises under 42 U.S.C. § 1395y(b)(2)(B)(iii) and 42 • C.F.R. § 411.37.

Liberty Mutual Insurance Company and the State of Michigan Second Injury Fund have both asserted subrogation liens for monies paid pursuant to the Michigan Workers’ Disability Compensation Act. In addition, the federal government is legally entitled to assert a subrogation lien for the monies paid, or that will be paid, as federal benefits under Medicare’s MSP provisions. See id. Plaintiffs complain that they are unable to settle their state law tort action without knowing the amount that the fed^ eral government will require in reimbursement or the amount-to be set-aside for future páyments. According to Plaintiffs, the Secretary will not provide the information that they seek in this federal civil action.

B. The Medicare Secondary Payer Statute

Congress created the Medicare program to pay for medical care of the aged, disabled, and those suffering from end stage renal failure. 42. U.S.C. § 1395, et seq.; Henry Ford Health Sys. v. Shalala,

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376 F. Supp. 2d 746, 2005 U.S. Dist. LEXIS 14224, 2005 WL 1661074, Counsel Stack Legal Research, https://law.counselstack.com/opinion/walters-v-leavitt-mied-2005.