Miniet v. Sebelius

Filing 25

ORDER denying 20 Motion for Summary Judgment; granting 21 Motion for Summary Judgment, AND CLOSING CASE. Signed by Judge Patricia A. Seitz on 7/18/2012. (lh)

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red
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ney- r nt nfde
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r quie b CM S g dei s Ass h, heCM S co r c ormadea a s ptonm or f vor bl t
e rd y
ui lne .
uc t
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Pl i ift n r quied,na ey t tt e tm a e ove pa e i bas on a ni t fve pe c t
antf ha e r
m l ha he si t d r ym nt s ed
ney i
r en
c nc t tt a t love a e ti hi he as o
ha e ha he c ua
p ym n s g r ppos t a ni t pe ce tc ncet tt a t
ed o
ne y r n ha
ha he c ual

ove a
m ymenti hi he . Fi ly,t Counc lf
s g r na l he
i ound t tbe us t us ofs mplng c eae a
ha ca e he e
n i r ts
pr s
e umptonofvai t ast t n ountofa ove pa e ,ti Pl i ifsbur t pr t tt
i
ldiy o he m
n r ym nt i s antf
den o ove ha he
sa itca s mplng m dhodol i i i
t tsi l a i
ogy s nvald.The Counc lc
i ondude t tPli ifha notm e hi
d ha antf d
t s
bur n. A s s h, he Counci r r ed t A LJ' de s on.
de
uc t
l eve s he
S ci i
C. TheIns antCa e
t
s

I t i lws i,Plitf s e j dca r ve a d rves lo t e Se rtr d cso a
n h s a ut an if e ks u iil e iw n e ra f h ceay e iin, s

rnd rdb t eCo n i. Boh p rish vemo e f rs mmayj d me t Th S ceay s e s
e e e y h u cl t ate a
v d o u r u g n . e e rtr e k
s mmayj d me to t eg o n t t e d cso i s p o td b s b tn il v d n e Plitf
u r u g n n h r u d ha h r e ii n s u p re y u sa ta e i e c . an if

manan t t ei e tte t s mmayj d me t n t a t Co r s o l rves teS c eay'
itis ha h s n ild o u r u g n a d h the u t h u d e re h e r tr s
de s on a r i t t t A LJ' de i i ba e on t r cor e de e.
cii nd e ns a e he
S c s on s d
he e d vi nc
l . I U SSI N
l D SC
O

4.Judii Reve o cr ar 'Decson
cal iw fse et y . ii
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a

J c a r vi w oft Se r tr sde son i a ia eunde t M e c r Ac . Se 42
udi i l e e
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U. C.j 1 f( ( ) Howe r rviw i lmie t d t rt r i s tnile de e t
S.
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.

r viw stfrh i 42U. C.j405(). tsubsa i e denc i mor t n ame es ntla. I
e e e ot n
S.
g)8 s tntal vi e s e ha
r ci il t
m e nss hr e nte de easar as
a uc elva vi nc
e onabl m i m iht cc pt a qua et s
e nd g a e as de t o uppor ac uson.
t oncl i
Thus s t nta e de e e s s w he t i ons s e c us ons c n be dr w n f om t s m e
, ubs a i l vi nc xi t
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Su r j g n i a p o rae whe çhe p e dig , d po iins a s r t
mmay ud me t s p r p it
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t

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i e r a ores a a isons o fl,t t rwih t a fda t ,i a s
ntr og t i , nd dm s i
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ha he e s

g n ieis ea t a ymaeil a t n t t h mo i gp ryi e t ldt aj d me t samatr
e un su s o n tra fc a d ha t e v n a t s ni e o u g n a
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ta teçi dng o te(e rtr a t a yfc,is p re b sbsa ta e d nc ,hal ec n lsv .
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2)
C.Cr sM otons Summar Jud
os- i for
y gment

By fln c o smo insfrs mmayj g n , h p risa ret a te ei n is o
iig r s- to o u r ud me t t e a t g e h t h r s o sue f
e
ma e i f c a t s eis sa eque tonsof1 f t Co tsde e mi ton.Pl i ifs ks
t ral a t nd he ol s ue r
si
aw or he ur' t r nai
antf ee

rve o teS c ea y s e iinta ( )h ALJd dn t a a t o i or ve t d tr n to
e iw fh e rtr ' d cso h t 1 te
i o h ve u h rt e iw he eemiain
yt
ofa s ti d orhi lve ofpa nter ;a ( t ALJere i fndi t s mplng
usane
gh e l
yme ror nd 2) he
r d n i ng he a i
m e hodol y a e r pol ton i ld. The Se r t r s ks a de e m i ton t the de s on i
t
og nd xt a a i nva i
c e a y ee
t r na i ha r ci i s

c it ntwih t lw a s
onsse
t he a nd uppored b s tntale de .
t y ubsa i vi nce
1 D e er i i n ofa Sus ai d or H i Le ofPaym entE r or
. t m nat o
t ne
gh vel
r

The M e c r Ac pr vi s t t ç m e c r c r c or m a not us e r pol ton t
di a e t o de ha $
a di a e onta t
y
e xta ai o
det r i ove pa e am ount t be r ove ed by r oupm ent of s t or ot r i e unl s t
e m ne r ym nt
so
ec r
ec
, fe,
he w s
e s he

S c ea y d tr n e t a t e ei a s sane o hgh lv lo y nte r r... 4 U. C.
e r tr ee miats h t h r s u ti d r i e e fpa me ro ' 2 S.
'
j1 9 d d ( 3 ( (mp a i a d d . Ad iin l ,te Ac s e iist a çh r s alb n
3 5 d 9( )A) e h ss d e )
dto al h t p cfe h t i e e h l e o
y
t
a miitai eo j dca rviw . . f d tr n t nsb t eSe rtr o s san do h g lv l
d n srtv r u iil e e . o ee miai y h ceay f u t ie r ih e es
o
o p y n er r ..' 2U. C.j1 9 d d ( 3 . I h rM oin f rSu r J d me t t e
f a me t ro s .
'4 S. 3 5 d 9( ) n e to o mmay u g n , h
S c emyman ansha a mi srtv a dj dca rv e aesauo iyf rco e wihrs c t
e rt
iti t t d nitaie n u iil e iw r ttt rl o e ls d t epe to
whe he t e r polton s d ha be n conduc e be us t Se r t r t ough t CM S
t r he xta a i houl ve e
t d ca e he c e a y, hr
he
conta t , ound t tt s m pl ha a 1 pe c nt y e e r r e.The Se e ar m a nt i t t
r c or f
ha he a e d 00 r e pa m nt r or at
cr t y i a ns ha
t s c tt esa i plc tde e m i ton t tt r w a a s t i d orhi h l velofpa e e r
hi ons iut n m i i t r na i ha he e s us a ne
g e
ym nt r or

and,a s h, xta ai waspr r g 21a 1 .
s uc e rpolton
ope .DE t 21 Howe r Pl ntf ague t tt Se eay
ve , ai if r s ha he crtr
di notm a a e i tde e m i ton of a s t ne or hi l ve ofpa e e r ,w hi h i a
d
ke n xplci t r na i
usai d
gh e l
ym nt r or
c s

c n i o p e e e tt u ig e ta lto a d tus a miitai e a d j d ca rviw ae
o dt n r c d n o sn xrpoain, n , h , d n sr tv n u iil e e r
i
9

p r te ( 2 a 2 .
e mi d.DE 4 t 1
t
He e,t Counc ls fndi t tt Se r t r de e m i d a s t i d o hih lve of
r he
i' i ng ha he c e a y t r ne
usane r g e l
pa e e r i s
ym nt ror s upporedbys t ntal vi nc TheCM S c r corco l dt t1 pe c nt
t
ubsa i e de e.
onta t ncude ha 00 r e

oft sxt cli t yr e ddurngt a ts dha be n de edpa nt ( 1 a 9,
he i y ams he eviwe i he udi houl ve e ni yme . DE 4 t
6016021 Clal afndi ofa 1 pe c nter rt c tt e a S usane orhih l lof
- . e ry, i ng
00 r e ror ae onsiuts t ti d
s
g eve
pa
ymen e r 'a c e aedbyt M edi r Ac .Pl i ifpr desnolga a hort t s
t ror' s ont mpl t
he
ca e t antf ovi
e l ut iy o uppor
t
hi c e i n t tt Sec e a ym us e es l s a et t de e na i n ofas t i o hi h l vel
s ont nto ha he r t r
t xpr sy t t ha a t nni t o
us a ned r g e

ofpa m e erorwasm a i aca elket sone whe e 1 per e oft s mpl cli ss d
y nt r
de n
s i hi
r 00 c nt he a e am houl
ha bee de ed pa m e .Thus s t tale de i t r or s
ve n ni
y nt
, ubs an i vi nce n he ec d uppors t tt Se r t r
t ha he c e a y,

t ought CM S c r t , a t r quieddetr i tonofas t ne orhi l l pa nt
hr
he
ontacor m de he e r
e m na i
usai d
gh eve of yme
e r t r y a l ngt e r pol to t beco
ror he eb lowi he xta ai n o
nduced.Furhe ,hedee mi tonofas t i
t
t rt
tr nai
usaned

o h g lv l f a me t ro ( ee 1 0p r e t i n t u j c t a miitai eo j dca rviw.
r i h e e o p y n er r h r , 0 e c n) s o s b e to d n srtv r u iile e
4 U. C. 3 5 d ( 3 .Ass h t eSe rtr i e tte t s mmayj g n o teis eo
2 S. j1 9 d d 9()
uc ,h ceay s n i d o u r ud me t n h su f
l
w he he t e r pol ton s d ha bee c uc ed.
t r he xt a a i houl ve n ond t
2.V aldiy oft St t s i alM e hodol f Ext apol i
i t
he a i tc
t
ogy or r
aton
Pl i if m a n a ns t t t Counci' fndi c e ni t valdiy of t sats i a
a ntf
i t i ha he
ls i ng onc r ng he i t
he t i tc l

me hodol
t
ogy us d t conduc t e r polton i no s ppored by s t i e de e.
e o
t he xta a i s t u
t
ubsantal vi nc

Spe iialy, antf a s rst tt mehodol i ta frt r a ons ( )t r weei ntc l
cfc l Pli if s e t ha he t ogy sl wed o wo e s : 1 hee r de ia
cli a unt i muli esr a, c i caesovelppi sr a; nd( srttc tonwa done
am mo s n tpl tat whih ndi t
ra ng tat a 2) taii ai s
by cam rt rt n by be iir ( 20 a 11 1 . The Se r tr a g st tPli ifs
li ahe ha
nefcay. DE
t - 3j
c eay r ue ha antf
c e insc r ngi ldiya enots
ontnto onceni nvai t z
upporedbyt r or ( 21at1 1 .
t
he ec d.DE
4- 9)
Fi s , ti undi put t tt Sec e a y m a utlze s a itca e r pol i t de e m i t
rt i s
s ed ha he r t r
y ii t ts i l xt a aton o t r ne he
10

amountofove pa e a t tt M PI pennist us ofsr tfe s
r ym nt nd ha he
M
t he e ta ii d amplng. Ass h,t
i
uc he
quesi i whe he t Counclsfndi t tt s m plng wa vald i s
ton s t r he
i' i ng ha he n i
s i s uppore by s tntal
td
ubsa i
e de e i t r c d. I
vi nc n he e or mpora l t s mplng u iied nee no be ba e on t m os pr c s
tnty, he a i tlz
d t
sd
he
t e ie

meh d lg ,u t vai meh d lg .DE 1 a 1 ) Mo e v rt eei ap eump ino v l iy
to oo y j s a ld t o oo y ( 4 t 0 . r o e,h r s rs to f ai t
d
w he s a i tca s m plng i us d by t CM S c r t and,a s h,t btr n i on Pl i ift
n t ts i l a i s e
he
ontac or
s uc he tde s
a ntf o

esa iht i ldiy oft mehodol ydurngt a nitai rvi (#.a 15 .
tbls he nvai t he t og i he dmi srtve e ew. f t 1
A st t fr ti s c er ng i ntc cl i a ount i m uli es r t , a ntf se r ,
o he i s s ue onc ni de i al a m m
sn
tpl ta a Pl i if xpe t

Dr BnzeKa don,saedi hi r por t tmuli esm ia cli i as mpl s d bec e a
. c r
t t n s e t ha
tpl i l r a ms n a e houl
ountd s

onecli i t dofa i pende cli .( 1 a 45,2071 M s Moya,heCM S c r t '
am nsea
s nde
nt ams DE 4 t
. .
t
ontacors
sa itcin, xpl i i he r por t tfvesr t wer c e t dby fr tt ngt t aln
ttsi a e aned n r e tha i ta a e r a e
is aki he ot mountpai
d

f a1o t cai i t t vere( 373, 22)a di di b fve( 735. .Thecl ms
or 1 f he l msn he mi s $2, 678. nd vi ng y i $474, 64)
ai
i t f a e w e e t s r e i a c ndi or rby t a ountpa d.The sr t w e e cr a e s h
n he r m
r hen o t d n s e ng de
he m
i
ta a r e t d uc

t tt cai i ea h sr t t t l d t cos tpos i e a ountt $474, 64. Ther a t ,
ha he l ms n c ta um o a e he l es sbl m
o
735.
e fer
t ve c a m s f om ea h s r t w e e r ndom l s e t t e lt s xt c a m s ne d f t
wel l i r
c t a um
r a
y el c ed o qua he i y l i
ede or he

s mpl g o p. DE 1 a 4 - 3 7 1 s Mo asae ta t i meh d lg E sa ls e awel
a e r u ( 4 t 2 4 , 5 .M . y ttd h t hs t o oo y i tb ih d
e
l
d fn dlmi b t e srt s n o ra pigwo l b po sbl. Vd a 7 1
ei e i t ewe n taa o o velp n ud e si e' . t 5 .
'
I r e ngt r c d, antf ha notc ef wa dwih e de et r f t M s M oya'
n eviwi he e or Pli if s
om or r t vi nc o e u e .
s
as e to t tt sr t we e non- ve lppi As s tf t above,M s M o expl ne t tt
s rin ha he ta a r
o ra ng.
e orh
. ya
ai d ha he
s m pl des g e t bls s t t t s r t a e non- r a ng. Pl i if f is t poi t r cor
a e i n s a i he ha he t a a r
ove l ppi
a ntf a l o nt o e d
evi nc t s
de e o uppor hi a s r i t tt f tt t r w er i ntc lc a m n ount i m uli e
t s s e ton ha he ac hat he e
e de i a l i m
sn
tpl
s r t de ons r t st tt s r t wer ove l ppi pa tc a l gi n t f c t tCM S a s r e
ta a m t a e ha he t a a
e r a ng, r i ul ry ve he a t ha
s e td
durng t a i s r tve r vi w t ti i no unus lt ha m uli e c a m sw ih t s e dola
i he dm ni ta i e e ha t s t
ua o ve
tpl l i
t he am
lr
11

v l b c u et eijcinsa is ea ep ie a bildb u t p o i da dt eeo e s v rl
aue e a s h ne to t su r rc d nd le y ni r vde n h rf r , e ea
s
camswo l h vet e s me p i a u t ( 1 a 1 1 TheM PI sae t a l an a p a
li
u d a h n ad mo n . DE 4 t 0 .
M tt s h t ç l p e l
g
c lngng t vai t oft s mplng m ehodol y mus bepr c t d on t ac ualsa itc l
hale i he ldiy he n i
t
og
t
edia e
he t ttsi a

vai t oft smpl a dr a c
ldiy he a e s awn nd onduce ' SeeMPI Se ton 8. 11 (mpha i a )
td.
'
M ci 4..9 e
ss dded .
Thus upon a r vi oft r co d, he fndi t tt s r t ar non- ve l ppi i s
,
e ew
he e r t i ng ha he ta a e
o ra ng s uppor e by
td

s t nta e de easPl ntf ha notc
ubsa i l vi nc
ai if s
ome f wa d wih a t le de eoft i ldiyoft
or r t c ua vi nc
he nva i t
he
s m plng de i
a i
s gn.

Pl n ifalo ma n a nst tt me hodol y i i ld be aus t sr tfc ton wa done
aitf s
i t i ha he t
og s nvai c e he ta ii a i
s
byc am r t rt nbybene i a y. ALJf
l i a he ha
fcir The
oundt sm e hodol i i bas donahy t tc
hi t
ogy nvald e
po he ial
hepos d, pe fcal t t
e s cii ly ha :

(f abe fcar ha 60s paat s vc e chwihisowncam numbe,he t snic s
1j ne ii y d e r e er ies a t t
li
rt n he e e
f rhso eb n fcayc u dc n tt t tee tr smpl g o p.No ltssy ( an it
o i n e eiir o l o siue h n ie n e r u
w,e' a Plitf
l
l tt m e ca r or f t sonebe fca y.Thi woul r ul i a 1
os he di l ec ds or hi
ne i ir
s
d es t n 00% e r rr t f
r o a e or
l c ofdoc e a i The t sr ul woul be e r pol ed t t f a e t pr
ak
um nt ton. n, hi es t
d
xt a at o he r m o oduc t
e he
s t nta o r ymentamount des t t f c t ti ma bet onl be fcir i t
ubsa il ve pa
, pie he a t ha t y he y ne i a y n he
f a e w ih l tr c ds
rm
t os e or .

( 1 a 4 j Ho v r te ei n e ie c i t rc r t s g e th th s e ai p ie b
DE 4 t 6 . we e ,h r s o vd n e n he e o d o u g s ta te c n ro ostd y
t ALJocc r di t sc s Furher t M PI s c fcal pe t s m plnguniscomprs d of
he
ure n hi a e. t , he
M pe ii ly nnis a i
t
ie
i vi cli . Se M PI ,Sec i 8. 3. 1 Addii ly,Pli ifdoesnote an i hi
ndi dual a ms e
M
ton 4. 2.0
tona l a ntf
xpl i n s
M oton f Summ a y J dg e why sr tf ng by c am i tad ofby be fca y i saitc ly
i or
r u m nt
ta iyi
l i nse
ne i ir s t tsia l
i ld. I t d, r f r gene a l t Dr Kz ndon' r por a t t s i ony a t he rngbe or
nva i nsea he e e s
r ly o . a
s e t nd he e tm
t he a i
f e

g pt r8, S dmi sr tveA ci a St tsialSa plng f Over m e Esi es'oft M PI i
cha e é
A nitai
tons nd aitc
m i or
pay nt tmat , he
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M s
pu i y a ia eont i e n a :
blcl valbl
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(. 2.

12

teALJ g 2 a 1 1 Ho v ra t eCo ncl e og z d Dr Ka d na s rs nyt a hewo l
h
. DE 0 t 7 . we e , s h u ir c nie , . r o s et o l h t
ud
h v c n u tdtesmpi gi ad fee t n e ta teCM Sc n rco dd.DE 1 a 1 1 Th s
a e o d ce h a ln n ifrn ma n rh n h
o ta t r i ( 4 t 4 . i
i i ufi i nt or ve s t Counci' dec son be us t r lva i r i notwhehe t mos
s ns fc e t e re he
ls ii
ca e he ee nt nquiy s
t r he t
pr c s s mplngm ehodwa us bu r t rwhe he ava i m ehodol wasus d.Lasl t t
e ie a i
t
s ed, t ahe
t r ld t
ogy
e
ty, o he
e e t tt sa itca me hodol us i t s c e was notoptma ,t CM S c r c or
xt nt ha he t tsi l t
ogy ed n hi as
i l he
onta t

a ountd f t sby usng ani t fvepe ce c i ncei e va andr i isove pa nt
cc e or hi
i
ne y-i
r nt onfde
nt r l
educng t
r yme
esi et t l rbound oft co i nc i e v . s h,t c r c o a s e t tt r
tmat o he owe
he nfde e nt r al As uc he onta t r s um d ha he e
was a ni t i per e c nc t t t acual ove a e i hi r t n t a s s d
ne pfve c nt ha e ha he t
m ym nt s ghe ha he s es e

o ep y n .DE 1 a 1 q Th s t eei s b tn il v d n et s p r teS ceay sfn i g
v r a me t g 4 t 5 . u ,h r s u sa ta e i e c o u po th e rtr ' id n
t tt me hodol us d i va i
ha he t
ogy e s ld.
1 1 CONCLUSI
1.
ON
Fort r as s tf t a
he e ons e orh bove,ti
i s
OR DER ED TH AT

()Plitf sM oi nf rS mma yJ d me ti DENI ( 2 1
1 anif
to o u r u g n s
ED.DE 0 .
()Dee d n ' M oi nf rS mma yJ d me t sGRANTED.( 21 .
2 fn a ts to o u r u g n i
DE 1

( )Th sCASE i CLOSED.
3 i
s

&

DONEANDORDE i MimiFl i t s / dyo Jl,02
RED n a orda, hi i a fuy2 1.
,

%

PAT Cl
A
Z
UN I
TED STAT S DI
STRI J
CT UDGE
cc:

Honor bl Andr M .Si
a e
ea
mont
on
Al c
l ouns lofr or
e
ec d

13