Ellis v. Department of Health and Human Services et al
ORDER granting 6 defts' Motion to Dismiss and dismissing the case without prejudice. Signed by Judge Billy Roy Wilson on 4/23/12. (kpr)
IN THE UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF ARKANSAS
ROBERT L. ELLIS
Personal Representative of the Estate of
Dorothy F. Bishop, Deceased
DEPARTMENT OF HEALTH AND
HUMAN SERVICES, et al.
Pending is Defendants’ Motion to Dismiss (Doc. No. 6). Plaintiff has not responded, and
the time for doing so has passed.1 For the reasons set out below, the Motion is GRANTED.
Medicare is a federally funded health insurance program for the elderly and disabled. On
May 14, 2010, Dorothy Bishop, a Medicare beneficiary, died from injuries she sustained in an
August 18, 2009 car accident.2 Two insurance companies paid policy limits in connection with
Ms. Bishop’s accident in a total amount of $75,000.3 A Medicare Secondary Recovery
Contractor (“MSPRC”) issued a demand for payment to the decedent’s estate in the amount of
$49,228.04.4 The demand letter explained that “the law requires Medicare to recover . . .
payments if payment of a liability settlement, judgment, recovery, or award has been or could be
made.”5 The letter also explained the beneficiary’s right to request a waiver if she disagreed
with the amount she allegedly owed, and set out the beneficiary’s right to appeal the
A response was due by Thursday, April 19, 2012.
Doc. No. 7.
Doc. No. 7, Ex. 3.
determination within 120 days.6 On August 30, 2011, Plaintiff asked for a partial waiver of the
demand in the amount of $25,000,7 but, based on the record, never appealed the determination.
The MSPRC denied Plaintiff’s request for waiver on March 3, 2012.8 The denial again
outlined the recipient’s right to appeal: “you have 120 days from the date you received this letter
to request a redetermination (to appeal our waiver of recovery determination).”9 I am not aware
of whether Plaintiff appealed this denial, and the time for doing so has not yet run.
Under the Medicare regulations, there is a detailed administrative review process
available to a beneficiary who is not satisfied with the result she received.10 The last step in the
process is judicial review. As set out above, Plaintiff apparently has not appealed the denial of
the request for waiver, and she still has time to do so. Until Plaintiff has exhausted the available
administrative remedies and a final decision has been issued, this Court lacks jurisdiction.11
Accordingly, Defendants’ Motion to Dismiss is GRANTED and this case is DISMISSED
IT IS SO ORDERED this 23rd day of April, 2012.
/s/ Billy Roy Wilson
UNITED STATES DISTRICT JUDGE
Doc. No. 7, Ex. 5.
Doc. No. 7, Ex. 7.
42 U.S.C. § 1395ff; 42 C.F.R. § 405.940 et seq.
42 C.F.R. § 405.1130.
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