Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Lewis v. Sebelius

United States District Court, Ninth Circuit

September 6, 2013

DENNIS GREY LEWIS, Plaintiff,
v.
KATHLEEN SEBELIUS, Secretary of Health and Human Services, Defendant.

REPORT & RECOMMENDATION

MARK D. CLARKE, Magistrate Judge.

Plaintiff Dennis Lewis ("Lewis"), pro se, seeks review of a final decision by the Medicare Appeals Council (MAC) holding that Lewis did not experience a major life-changing event that justified using a more recent tax year to calculate his income-related monthly adjustment amounts ("IRMAAs") to his Medicare Part Band Part D premiums for 2011. Judicial review is authorized by 42 U.S.C. § 1395ff(b)(1)(A)and § 405(g). For the reasons below, the MAC's decision should be affirmed, and the defendant's motion for summary judgment (#31) should be GRANTED.

LEGAL STANDARD

The MAC's ruling is the final decision of the Secretary, Conahan v. Sebelius , 659 F.3d 1246, 1249 (9th Cir. 2011) (citing Beckler v. Ringer , 466 U.S. 602, 607 (1984)); thus on judicial review, the court must uphold the MAC's factual findings if they are supported by substantial evidence. 42 U.S.C. § 405(g); Mayes v. Massanari , 276 F.3d 453, 458-59 (9th Cir.2001).[1] Substantial evidence is "more than a mere scintilla, " which means "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales , 402 U.S. 389, 401(1971) (citation and internal quotation marks omitted). The agency's interpretation of its own regulations receives "substantial deference" and "must be given controlling weight unless it is plainly erroneous or inconsistent with the regulation." Thomas Jefferson Univ. v. Shalala , 512 U.S. 504, 512 (1994) (citation and internal quotation marks omitted).

"A reviewing court may not substitute its own judgment for that of the agency." Memorial, Inc. v. Harris , 655 F.2d 905, 912 (9th Cir. 1980) (citing Citizens to Improve Overton Park, Inc. v. Volpe , 401 U.S. 402, 416, 91 S.C. 814, 824 (1971)). Under the Administrative Procedure Act, the reviewing court must affirm the Agency's determination unless it is "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law." 5 U.S.C. § 706(2)(A). A decision is arbitrary and capricious if the agency "has relied on factors which Congress has not intended it to consider, entirely failed to consider an important aspect of the problem, offered an explanation for its decision that runs counter to the evidence before the agency, or is so implausible that it could not be ascribed to a difference in view or the product of agency expertise." O'Keefe's, Inc. v. U.S. Consumer Prod. Safety Comm'n , 92 F.3d 940, 942 (9th Cir. 1996) (quoting Motor Vehicle Mfr.'s Ass'n v. State Farm Mut. Auto Ins. Co. , 463 U.S. 29, 43 (1983)).

REGULATORY FRAMEWORK

The Social Security Act requires beneficiaries whose modified adjusted gross income (MAGI) exceeds a threshold amount to pay an adjusted premium, or IRMAA, for Medicare Part - B and Part D. In ordinary circumstances, regulations require that the SSA use the MAGI provided by IRS for the tax year two years prior to the effective year of the IRMAA determination. 20 C.F.R. § 418.1135(a). The SSA will use tax information from a more recent tax year if the beneficiary has experienced four conditions listed in 20 C.F.R. § 418.1201, the first of which is that the beneficiary experienced a "major life-changing event." 20 C.F.R. § 418.1201(a). A "major-life-changing event" is narrowly defined to include:

(a) Your spouse dies;
(b) You marry;
(c) Your marriage ends through divorce or annulment;
(d) You or your spouse stop working or reduce the hours of your work;
(e) You or your spouse experiences a loss of income-producing property, provided the loss is not as the direction of you or your spouse (e.g., due to the sale or transfer of the property) and is not a result of the ordinary risk of investment. Examples of the type of property loss include, but are not limited to: Loss of real property within a Presidentially or Gubematorially-declared disaster area, destruction of livestock or crops by natural disaster or disease, loss from real property due to arson, or loss of investment property as a result of fraud or theft due to a criminal act by a third party;
(f) You or your spouse experiences a scheduled cessation, termination, or reorganization of an employer's pension plan;
(g) You or your spouse receives a settlement from an employer or former employer because of the employer's closure, ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.