AC TIO N A LLIA NC E OF SEN IOR

CITIZENS, et al., P lai nt iffs,

v. CH ARLES E. JOH NSO N, Ac ti ng Se c r e ta r y o f De par tm e ntof He alt h and Hum an Se r vic e s, e t a l.

De fend ant s. UNITED STAT ES DIS TRICT COURT F OR THE D ISTRIC T OF CO LU M BIA

Ci vi l A cti on 06 -01 60 7 (H HK)

M EM OR

AN DU M OP IN ION Action Alliance of Senior Citiz ens (“ Action Alliance ”), the Gra y Panthers, and L

ucy Caroly n L oveall (tog ether , “Plaintiffs”) br ing this ac tion ag ainst defe ndants Charles E. Johnson (“Sec reta ry”) in his offic ial capa city as Ac ting Sec reta

ry of the De partment of H ealth and H uman Service s (“HH S”) and Micha el J . Astrue ( “Commissi oner” ) in his official c apac ity as Commi ssioner of the Socia l Security Administration (“SSA”) (tog ether , “De fenda nts”). Plaintiffs bringtheir cla ims in response to the Secr etar y ’s ef forts to rec over e rrone ous Medicar e pre mium pay ments sent to approxim ately 230,000 participa

nts in the Medicar e Part D Pre scription Drug Plan (“Part D” ) includingL oveall and pa rticipants belong ing to the A ction Alliance or the Gra y Panthers (tog ether , “Medic are Participants”) . Plaintiffs seek injunctive, dec laratory , and
mand amus re lie f r e qu ir ingthe Se c re tary to p ro vid e the Me dic are Part ic ipa nts wi th n oti c e of

the ir putative rig ht to seek a w aiver of re cover

y , a per iod within which to ex erc ise their rig hts, and a hear ing. F or those Medic are Participants who have returne d the pre miums, P laintiffs seek a courtOn September 27, 2006, this court issued an orde r g rantingthe Plaintiffs’ motion for a 1 preliminary

injunction and denying the Def endants’ motion to dismiss
. Action Alliance of Senior Citi ze ns v . Le av itt , 456 F. Supp. 2d 11 (D.D .C. 2006) (“A ction Alliance I ”). The U.S. Court of Appea ls for the D.C. Circuit vac ated that or der a nd rema nded the c ase. Action Alliance of Senior Citi ze ns v . Le av itt , 483 F.3d 852 ( D.C. Cir. 2007) (“A ction Alliance I I ”). A fter the case was rema nded, a supple mental and se cond ame nded complaint wa s filed that included the Commis sio ne r a

nd L ov e a ll, ne ith e r o f who m w e re pa rt ie s to thi s a c tio n in

the or ig ina l c omp la int
. 2 or de r t hat w ou ld r e qu ir e the Se c re tary to r e tur n th os e fu nd s to tho se Me dic are Part ic ipa nts un til they have be en notified of a

nd g iven an oppor

tunity to reque st the afor ementioned wa iver. B e fo re the c ourt

are De fe nd ants ’ m oti on

to d ism iss the c omp la int [#49 ], and

Pla int if fs ’ cross-motion for summar y judgme nt [ #50]. Upon consideration of the motions, the oppositions there to, and the re cord of this case, the c ourt conc ludes that Def endants’ motion should be g rante d and Plaintiffs’ motion should be denied. I. BACKG ROUND The ba ckg round fa cts conc erningthe Medica re pr og ram, Medic are Part D spec ifically , and the fa c ts g ivi ngri se to t

his lit ig atio n a lon g wi th i ts p ro c e dura l hi sto ry are tho ro ug hly

se t f or th i n the D.C. Circuit’s opinion in thi s case : 1 Medica re Par t D, established by

the Medica

re Prescr iption Dr

ug , I mprovement, a

nd Modernization Act of 2003, Pub. L . No. 108-173, 117 Stat. 2066, off er s subsidiz ed presc ription drug insurance cover ag e. 42 U.S.C. § 1395w-101(a) (1). Where as under Medica re Par ts A and B the g overnment pay s providers on pa rticipants’ be half for g oods or servic es re ceive d, under Part D t he gover nment contra cts for a

nd subsidiz es insurance plans offe red by private, third- party

insurers. Id. at § 1395w-115. Part D par

ticipants pay

monthly premiums to their insurers. See id. § 1395w-113(a ). Most make t h es e pay

ments directly , but about 20% have opted to have the [S SA] de du c t th e amou

nt o f t he ir Part D p re mi um fro m th e ir

monthl y be ne fi ts und e r T itl e I Iof the S ocial S ecur ity Act and transmit that sum, on the par ticipant' s behalf, to the insurer. Id . § § 1 39 5w -1 16 (b )( 3) & 13 95 w-2 4(d )(2) (A ); see also 42 C.F.R. §§ 42 3. 29 3( a ) & 42 2. 26 2( f) (2 00 6)
. [Qu a lif ying low -i nc ome pa

rt ic ipa nts may have the ir premiums subsidiz ed in full or in pa rt by the g overnme nt. 42 U.S.C. § 1395w-114.]3

The SSA, which plaintiffs have not sued, administers Old-A g e, Survivor, and Di sa bil ity Ins ur anc e be ne fi ts und e r Tit le I Iof the Soc ia l Se c ur ity

Ac t; [H HS] administers the var ious Medicar e programs found unde r Title XVI I I of t hat Act. Si nce 1994 the S SA, direc ted by the [ Commi ssioner], has been independe nt of HHS. See Social Security

Independe nce a

nd Prog ram I mprovements Act of 1994, Pub. L . No. 10 3- 29 6, 10 8 St at. 1 46 4; 4 2 U .S. C. § § 4 01 -4 34 (T itl e I I ); id. §§ 13 95 -1 39 5hhh(T itl e XVI I I ). In a monumen t al gaf

fe in e arly

August 2006, the SS A wrote to some 230,000 participa nts, stating “[w]e will no longe r deduc t money for your hea lth plan premium (s ) fr om y our monthly benef its.” The letter

also said, without further e xplanatio n, tha

t the add re sse e wo uld

be re c e ivi nga

c he c k in a sp e c if ie d amou nt, coincidingwith the rec ipient's pr emium for the just-past month. The aver ag e pay ment wa s $ 21 5, fo r a tot a l of so me $4 7 mi lli on . T he pa rt ie s a g re e the se pa

y me nts we re a ll made in er

ror. In ear ly

September, the Secre tary reque sted repa

y ment of the funds by the end of that month, but indicated that “[i] f returning the amount i n full prese nts y ou with a har dship, y ou may

reque st to make monthly

installment pay

ments for as many as se v e n mo n th s . ” T h e Se c r e ta r y ' s le tt e r a ls o s tate d ( a c c ur a te ly ) th a t d e s p ite the mistaken pay

ment to the insured, “pr escr iption drug c ov er age will continue uninterrupted.” On S eptember 15, Action Alliance and the Gr ay Panthers . . ., advoc acy

org anizations whose membership includes many Part D participa nts, f iled suit in distric t co u rt seekinginjunctive, decla

ratory , and mandamus relief on statutory and constitutional g ro un ds . ( Th e pla int if

fs late r a me nd e d th e ir c omp la int to a dd Luc y Caro ly n L ov e a ll, a Part D pa

rticipant who rece i v ed a c heck f or $161.70, a sum which she spent and states she is now unable to repa y .) The c omplaint rested in par t on 42 U.S.C. § 1395g g , which allows the g overnme nt to recove r funds whe re “ more than the corr ect amount is paid under th[ e] [Medica re] subchapte r . . . for items or se rvice s furnished ani n d i v i d u a l , ” § 1 3 9 5 g g ( b ) , b u tp r o v i d e s f o r g o v e r n m e n tw a i v e r

o f th i s r e c o v e r

y: Th e re sh a ll b e no a dju stm e nt a s pro vide d in su bs e c tio n ( b) of

thi s section (nor

shall there be rec overy

) in any case wher e the incor

rec t pa y me nt h a s b e e n ma de
. . . w ithre sp e c t to an in div idua l w ho is with o u t fa u l t . . . if such adjustment (or rec overy ) would def

eat the purp os e s of s ub c ha

pte r I I[Old -A g e , Surv ivo rs , a nd Di sa bil ity Insuranc e] or subchapte r XVI I I[Medicare ] of this c hapter or would be ag ainst equity

and g ood conscie nce. 42 U.S.C. § 1395gg (c)
. The Alliance asser

ted that Part D participa

nts who rec eived err oneous pay ments were entitled, under § 1395g g , to “written no tice . . . of the ir rig ht to seek wa iver of4

repa y ment” and a

n oral hear ing prior to r ecove ry of such pay ments. The district cour

t reje c te d th is c la im , n o ti n g th at § 1 3 9 5 g g a p p li e s o n ly to p ay

me n ts f o r “ it ems or service s” (such as under Medica re Parts A and B) , and thus that its waiver provision did no t e nc omp a ss e rr on e ou s premium ref unds. Action Alliance I

, 456 F. Supp. 2d at 18. B ut t he c ourt ob se rv e d th at Me dic are Part A and B par

tic ipa nts wh o a uth or ize SSA to wi t h h o l dtheir pre miums under those parts do e njoy a wa iver rig ht for er

roneous premium ref

unds. Interna l SS A policy g uidelines, in the form of its Prog ram Oper ations Manual Sy stem (“P OM S ”) , cre ate suc h a rig ht on the basis of Title I I ’s g ener al waiver provision, 42 U.S.C. § 404(b). Action Alliance I , 456 F. Supp. 2d at 18 -2 0; se e als o Social Security Administration, Progra m Operations Manual Sy stem § HI 01001.330.A. Section 404 addre sses adjustment or rec overy of incorre ct pay ments to T itle I I(Social Security ) bene ficiar ies “[w]henever the Commi ss i o n er of Social Security finds that more or le ss than the cor

rec t amount of pay

ment has been made to any person unde r th i s [ T i t l e II ] s u

b c h a p t e r . ” 4 2 U
. S
. C
. § 4 0 4 ( a )
. S e c t i o n4 0 4 ( b ) g o e s o nt o s ay: In any case in which more tha

n the cor rec t am o u n t of pay

ment has been m a d e , th e r e s h a ll b e n o a d ju s tm e n t o f

p ay me n ts to , o r

r e c overy by the United States fr om, any person who is w ithout fault if such adjustment or re cover

y would defe at the purpose of this subchapter or would be ag ainst equity

and g ood conscie nce. Id . § 404(b). Although the POMS was sil ent as to waiver for errone ous ref unds of Pa rt D pre miums, t he district cour t [ conclude d] t hat the “statutory scheme ” re quired that Part D be nefic iaries r ece ive the same treatment as t hose under Parts A and B
. Action Alliance I , 456 F. Supp. 2d at 20. [Therefor e, the district cour t gr an t ed P laintiffs’ motion for a preliminary

injunction and] order ed the Sec reta ry to re -re turn the e rr on e ou s p ay

me nts to P art

D p art ic ipa

nts wh o ha d re pa id t

he m and to notify all rec ipients of a rig ht to request a ha rdship waiver
. Action Alliance II

, 483 F.3d at 854-55 (interna l rec ord citations omitted) (alter ation in orig inal). Def endants a ppeale d, and the D.C. Circuit vac ated this court’ s preliminary injunction
or de r a nd re mand e d th e c a se . With r e sp e c t to thi s c ourt ’s fi nd ingof a me ri tor iou s w a ive r c la im under 42 U .S.C. § 404(b), the D.C. Circuit held that this court lacke d jurisdiction to consider the5

claim bec ause Plaintiffs did not prese nt it to t he Commissi oner be fore seekingjudicial revie w as require d by

42 U.S.C. § 405(g) -(h) and bec ause the exis tence of an a dminist rative r emedy prec luded mandamus jurisdiction. See A ction Alliance II , 4 8 3 F. 3 d at8 5 6 -5 8 (c i t i n g W

einberge r
v . S alf i , 4 2 2 U. S
. 7 4 9 (1 9 7 5 ))
. W i thre s p ec tt o P l ai n t i ff s ’ w ai v er cl ai mun d er

4 2 U. S
. C
. § 1 3 9 5 gg, the D. C. C ir c uit

a g re e d w iththi s c ourt

in h old ingthat th e c la im l a c ke d me ri t be c a us e “ by its pla in terms, 1395g g applies to overpa y ments to a ‘provide r of se rvice s’ for ‘ items or service s furnished an individual.’ It has nothing to do with er roneous r efunds of

Medica re pr emiums.” Action Alliance II

, 483 F.3d at 860-61. Followingthe D.C. Circuit’s dec ision and in an appa rent e ffor t to meet the jurisdictional require ments set forth in that dec ision with respect to a w aiver claim under

42 U.S.C. § 404(b), Plaintiffs’ counsel sent a

separ ate letter

from ea ch of the plaintiffs to the Secre tary and the Commi ssioner askingthem to notify the Medica

re Par ticipants of their right to request a w aiver under 42 U .S.C. § 404(b) and how to exercise that rig ht. ( SeePl ’ s . Se c o n d A m. Co mp l. [# 4 7 ], Ex . B.) On August 16, 2007, Pl aintiffs re ceive d a re sponse from B eatr ice M. Disman, Chair of the SSA’s Medicar e Planning and Implementation Task F orce (“Chair ”) de nying the ir reque sts. ( Se e id ., Ex . H.) Spec ifically , the Chair re asoned that 42 U.S.C. § 404(b) did not apply to the
err oneous re funds of Part D pr emiums beca use such r efunds did not ca use Plaintiffs to rec eive more than the corr ect a

mount of Title I Isocial sec urity benef its; rather, Plaintiffs re ceive d the
corr ect a mount of Title I Ibenef

its. ( See id. ) Th e re a ft e r, Pla int if

fs fi le d th e ir

Se c on d A me nd e d Co mpl a int [#47 ]. In th a t c omp la int , Plaintiffs contend that De fenda nts’ ref usal to provide wr itten notice to Medica re Par ticipants of their rig ht to seek a w aiver of re pay ment and De fenda

nts’ failure to offer

Medica re Par ticipants anDef

endants c oncede that the cour t has subject matter

jurisdiction over L oveall’s c laim, and the 2 c ourt a g re e s. The c ourt reje cts Plaintiffs’ eff orts to re-c hara cter ize the errone ous Part D pre mium refunds as 3 any thing other

than pre mium refunds. See A ction Alliance II , 483 F.3d at 860-61 (holding that 42 U.S.C. 1395gghad nothing to do with the “er roneous r efunds of

Medica re pr emiums” at issue in t his c a se ); Action Alliance I , 456 F. Supp. 2d e n p as sim (adoptingPlaintiffs’ initial char acte rization of the err oneous pay ments as Medica

re Par t D premium ref

unds). 6 oral he aringprior to such re cover y violate 42 U.S.C. § 404(b), 20 C.F.R. § 404.501 et seq ., POM S § HI 01001.330B, a

nd the Due Proc ess Clause.

II. AN AL YSI S The brie fs of the pa

rties ra ise two principal issues. F irst, whether this court lacks subjec t matter jurisdiction over the claims raise d by Action Alliance and the Gr ay Panthers bec ause the y failed to mee t the prese ntment require ment. Second, whe ther the 42 U .S.C. § 404(b) waiver 2 provision applies to the err oneous re funds of Part D pr emiums, which are at issue in this case. 3 The c ourt will address these issues in turn. A. The Co ur t H as Subj e c t M at te r Jur isdi c ti on O ve r The Cl aim s R ais e d By T he As so c iat ion P lai nt iffs A c ti on A lli anc e and t he G r ayP ant he r s. Def endants c ontend that the cour t lacks subject matter

jurisdiction over the c laims of the two association plaintiffs, Ac tion Alliance and the Gra y Panthers, bec ause the se two plaintiffs have not satisfied the re quirement that they prese nt their claims to the Commiss ioner be fore seekingjudicial revie w. See42 U. S.C. §§ 40 5( g )- (h ); Action Alliance II , 483 F.3d at 856-58 (re lying on W

einberge r , 422 U.S. at 756, 763-64). Spec ifically , Def endants c ontend that the letters that Ac tion Alliance and the Gra y Panthers sent to the Commissioner did not satisfy the pr e se ntm e nt r e qu ir e me nt b e c a us e the y we re fr om t

he a sso c iatio ns rathe r t

ha n th e ir me mbe rs , (Pl’s. Second Am. Compl. [ #47], Ex . B) , and the c ourt has held that ne ither assoc iation hasTo the extent that Defe ndants seek to r ear g ue the c ourt’s holding that Action Alliance and the 4 Gra y Panthers have repr esentational standing, the court re jects their attempt. 7 org anizational standing. Action Alliance I , 456 F. Supp. 2d at 16 n.4. Althoug h this court has h el d th atAc t i o nAl l i an ce an d th e G ra y P an th er s h av e r ep re s en t at i o n al s t an d i n g, see Action 4 Alliance I

, 4 56 F . Su

pp . 2 d at 16 , D e fe nd ants sti ll c on te nd that th e a sso c iatio ns c ann ot e sta bli sh subject matter jur isdiction in t heir re prese ntational capa cities bec ause none of their membe rs have prese nted a c laim to the Comm issioner. Plaintiffs counter that Defe ndants’ position would have the cour t conflate the pre sentment requir ement with the re prese ntational standing analy sis, and that whether

individual members have prese nted a c laim to the Comm issioner ca nnot disturb the court’s holdingthat Action Alliance and the Gr ay Panthers have repr esentational standing. See id
. Def endants re join, in essence, that Plainti ffs have missed the point and in doing so confuse d the issue. Acc ordingto Defe ndants, repr esentational standing a lone is not enoug h for Ac tion Alliance
an d th e G ra y P an th er s t o m ai n t ai nth i s ac t i o n . Inad d i t i o nt o re p re s en t at i o n al s t an d i n g, Def endants point out that the D.C. Circuit has identified a se parate and indepe ndent hurdle that Plaintiffs must clear—the pr esentment re quirement. Ac cordingto Defe ndants, the assoc iation plaintiffs ca

nnot meet the pre sentment requir ement bec ause none of their membe rs have prese nted
a c la im t o th e Commis sio ne r a nd re c e ive d a

fi na l de c isi on

re je c tin g that c la im. The issue be fore the cour t is not whether Ac tion Alliance and the Gra y Panthers have standing but rather

whether they have satisfied the pre sentment requir ement and the reby established this court’s subjec t matter jurisdiction over their claims. Plaintiffs bear

the burde n of establishing subje ct matter jurisdiction. See Shuler v. United States , 531 F.3d 930, 932 ( D.C. Cir. 20 08 ). As the D. C. C ir c uit ob se rv e d in

va c a tin g thi s c ourt ’s pr e vio us or de r, the “ sta rt ingpo int [s]8

for a naly sis” of the subjec t matter jurisdiction question here are 42 U.S.C. §§ 405(g) -(h) , which contain the “ nonwaivable ” re quirement that Plaintiffs pre sent their cla ims to t he Commissi oner befor e see king judicia l review
. See A ction Alliance II , 4 8 3 F. 3 d at8 5 6 -5 7 (c i t i n g Mathews v. Eldridge , 4 24 U. S. 3 19 , 3 28 (1 97 6) ). Th is p re se ntm e nt r e qu ir e me nt s e rv e s a s a n “ a bs olute prer equisite” to re view and pr eclude s jurisdiction. Id
. at8 5 7 (c i t i n g Nat’l Ki dney Patients Ass’n v. Sullivan , 958 F.2d 1127, 1129- 30 (D.C. Cir. 1992)). The c ourt finds that Action Alliance and the Gr ay Panthers have satisfied the pre sentment require ment; theref

ore, this cour

t has subject matter

jurisdiction over their c laims. The ca se that de c ide s th e iss ue is Shalala v. Illinois Council on Long Term Care, Inc. , 529 U.S. 1 (2000) (“ Il lin ois Cou nc il ”). In Il lin ois Cou nc il , an assoc iation repre senting sever al nursinghomes filed
su it a g a ins t th e Se c re tary

inv ok ingfe de ra l qu e sti on jur isd ic tio n a

nd a lle g ingthat c e rt a in Medica re- related re g ulations violated various statutes and the Constit ution. Id . at 5. The district court dismissed the suit finding that it lacke d subject matter jur isdiction. Id . Specifica lly , the district court held that the pla intiff association could not esta blish subject matter jurisdiction beca use it had not prese nted a c laim to the Comm issioner befor e see king judicia l reviewas require d by

42 U.S.C. §§ 405(g) -(h)
. Id . Be fore the Supreme Court, the pla intiff association contende d that it should be ex cused f rom satisfying the prese ntment require ment beca use “[as] an association, not an individual, it [ could] not t ake a dvantag e of the specia l reviewchanne l” for prese nting a

claim. Id . at 24. The Court re jected this ar g ument finding that the association “spea ks only on behalf of its member[s] . . . and [i] t is essentially their rig hts to review that a re at stake.” Id . There fore , the Court held that either “[t] he assoc iation or its members” may satisfy the pre sentment requir ement bef ore se ekingjudicial revie w. Id . at 5. Thus, under Il lin ois9

Cou nc il , Action Alliance and the Gr ay Panthers may

satisfy the pre sentment requir ement of 42 U. S.C. § 4 04 (b ), and

the ir le tte rs to t

he Commis sio ne r d id s o. Ac c or din g ly , th e c ourt ho lds that it ha s su bje c t matte r j ur isd ic tio n o ve r t he c la ims ra ise d b y

Ac tio n A lli anc e and

the Gr ay Panth e rs . B. The 42 U. S.C . § 40 4( b) Ri ghtTo Se e k A W aiv e r Do e s N otApp ly T o Er r one ous Re funds o f Me dic ar e P r e m ium s. Plaintiffs contend that the Medic are Participants ar e entitled to notice of their rig ht to seek
wa ive r o f r e pa

y me nt o f t he e rr on e ou s p re mium r e fu nd s, the op po rt

un ity to e xer c ise the ir

ri g hts , and a he ari ng . D e fe nd ants c ounte r t hat no statut e or

re g ulatio n p ro vid e s th e Me dic are Part ic ipa nts with the rig ht to seek a w aiver of re cover

y . The issue boils down to a question of statutory interpre tation. The pa rties and the c ourt ag ree that in review ing this question of statutory interpre tation, the cour t must follow the two-step inquiry set forth in Chevron U.S.A. I nc. v. Natural Resource

s DefenseCouncil, Inc. , 467 U.S. 837, 842-43 (1984). Under Chevron , th e c ourt fi rs t in qu ir e s a s to “whe ther Cong ress ha s directly spoken to the pre cise que stion at issue.” Id . at 842. “I f the intent of Cong ress is clea

r, that is the end of

the matter; for

the cour t, as well as the a g ency , must give eff ect to the una

mbiguously

expressed intent of Cong ress.” Id . at 842-43. Sec ond, “[if] the cour t deter mines [t hat] Congre ss has not directly addre ssed the pre cise que stion at issue, the court does not simpl y

impose its own construction on the statute . . . .” Id . at 84 3. “ Rathe r, if the statut e is silent or ambig uous with respec t to the specific issue, the question for the c ourt is whether the ag ency ’s [int erpr etation] is based on a per missibl e construc tion of the statute.” Id . I f the a g ency ’s i n t er p re t at i o n“f

i l l s a gap o r d ef

i n es a t ermi na w ay

th ati s re as o n ab l e i nl i gh to f t h e l egi s l at ure 's
reve aled de sign, [the cour t give s] t he administrator' s judgme nt ‘controlling weig ht.’”10

NationsBank of N.C . v. Variable Annuity Life Ins. Co. , 513 U.S. 251, 257 (1995) (quoting Chevron, 467 U.S. at 844). The c ourt may disreg ard the ag ency ’s interpre tation, however , wher e it is “arbitrar

y , capr icious, an abuse of discre tion, or otherwise not in ac corda nce w ith law.” 5 U. S.C. § 7 06 (2 )( A) ; Citi

zens to Preserv e Ov erton Park, Inc . v. Volpe , 401 U.S. 402, 413-14 (1 97 1) ; Kent County v. EPA , 963 F.2d 391, 393 ( D.C. Cir. 1992). Procee ding to the f

irst step of the Chevron analy sis, the court asks whe ther Cong ress ha s sp ok e n to the pr e c ise qu e sti on at is su e ; na

me ly , w he the r t

he Me dic a

re Part ic ipa

nts have a ri g ht t o
re qu e st a wa ive r o f r e pa

y me nt o f t he e rr on e ou s Me dic are Part D p re mium r e fu

nd s. Pla int if

fs ’ purp or te d r ig ht t o r e qu e st a

wa ive r i s r oo te d in

pr ov isi on s o f t

he Soc ia l Se c ur ity

statut e ; na

me ly in “Subchapte r I I . Fe dera l Old-Ag e, Survivors, and D isability Insuranc e B enef

its” (“Title I I ”). Th e re in, Pla int if

fs re ly on § 4 04 , w hic h “ a dd

re sse s a dju stm e nt o r r e c ov e ry of inc or re c t pa y me nts to Titl e II (Social Secur ity) bene ficiar ies.” Action Alliance II , 483 F.3d at 855 (emphasis adde d). Th e pr ov isi on s o f § 40 4 g ra nt t he Commis sio ne r t

he a uth or ity to r e c ov e r e rr on e ou s p ay me nts

“ wh e ne ve r [h e ] . . . fi nd s th at mo re or le ss t ha n th e c or re c t amou nt o f p ay me nt h a s b e e n ma de to any person unde r this subchapter [Tit le I I ] . . . .” 42 U.S.C. § 404(a) (e mphasis added)
. Subsection (b), howe ver, pr ovides a limitation on the Comm issioner’s authority to rec over: [i ]n any case in which more tha

n the corr ect amount of pay ment has bee n made, ther e shall be no adjustment of p aym en t s to, or rec overy by the United States fr om, any pe rs on wh o is with out fa

ult if su c h a dju stm e nt o r r e c ov e ry wo uld de fe a t th e purp os e of thi s su bc ha pte r [Tit le I I ] or would be ag ainst equity and g ood conscie nce. 42 U.S.C. § 404(b) (empha sis added). The rig ht to seek a w aiver of re cover

y arises f rom the limit ation in § 404(b). The question here is not whether the r ight to see k a wa iver unde r § 404(b)The c ourt nee d look no further than the statute at issue in Action Alliance I for the pr oposition 5 that Congr ess say s so when it intends the waive r rig ht to reac h beyond Title I I . 42 U.S.C. § 1395g g (c) (“The re sha ll be no . . . rec overy . . . wher e the incor

rec t pay ment has bee n made . . . with respec t to an individual who is without fault . . . if such . . . r ecove ry would defe at the purposes of subc hapter

I Ior subchapter XVI

II . . . .”) ( emphasis adde d). 11 exis ts in the abstrac t but rather whether that waiver

rig ht applies to the err oneous Part D pr emium ref unds in this case. Def endants c ontend that the Medic are Participants ar e not entitled to seek a waiver of
rec overy beca use § 404(b) applies only to pay ments under “ this subchapter [Title I I ],” where as the
err oneous Part D pr emium refunds w ere made unde r “Subcha pter XV I I I . Hea lth I nsuranc e for Ag ed and D isabled” ( “Title XVI I I ”), not unde r Title I I . Plaintiffs counter that § 404( b) is not lim ite d to Ti tle I I , a

nd e ve n if it w e re so lim ite d, § 4 04 (b ) w ou ld a pp ly to t he e rr on e ou s Pa

rt D premium ref

unds at issue in this case be cause those ref unds were provided to the Medic are Part ic ipa nts fr om T itl e I Ifu

nd s. The c ourt’s interpr etation of §404 be g ins with the plain “text and the pr esumption that Congr ess ‘say s in a statute what it means a nd means in a statute what it say s there.’ ” Nuclear Energy I nst., Inc. v. E

PA , 3 7 3 F. 3 d

1 2 5 1 , 1 3 0 9 (D
. C
. C i r. 2 0 0 4 ) ( qu o t i n g Conn. Nat’l Bank v. Ge rm ain , 503 U.S. 249, 254 (1992)). The text here could not be cle are r: under § 404( a)- (b), the Commi ssioner’s rig ht to recove r and the concomitant rig ht to seek a w aiver of re cover

y are limit ed to pay

ments made “ under this subcha pter [Title I I ].” The statutory text provides no i n d i c a t i o nth atC o n g r e s s i n t e n d e d th e p r o v i s i o n s t o a

p p l y t o an y s u b c h a p t e r s o th e r

th anT i t l e II. 5 In d e e d , T i t l e X V III

d o e s n o ti n c o r

p o r at e § 4 0 4 a s i td o e s nu m e r o u s o th e r p r o v i s i o n s o f

T i t l e II: The provisions of sec tions 406 a nd 416(j) of [42 U.S.C.] , and of subsections (a) , (d), (e) , (h), ( i), (j), (k) , and (l) of section 405 of [42 U.S .C.] , shall also apply with respec t to this subchapter [Title XVI I I ] t o the s ame ex tent as they are applicable with respec t12

to subchapter

I Iof this chapter

[Tit le I I ], ex cept that .
. . any ref ere nce the rein to the Commi ssioner . . . shall be c onsidered a ref ere nce to the Sec reta

ry . . . .”). 42 U. S.C. § 1 39 5ii ; cf. Action Alliance I I , 4 83 F .3 d at 85 9 ( no tin g that “ § 4 05 (g ) i s c on sp ic uo us ly absent fr om the list of Titl e I Iprovisions incorporated into Medicar e by § 1395ii.”) To the e xtent th at Pla int if fs inv ite the c ourt

to r e a d a wa ive r r ig ht i nto § 4 04 (b ) t hat is broade r than the r ecove ry rig ht in § 404(a) simply

beca use § 404(b) ref

ers to “the purposes of [Tit le I I ]” in contrast to § 404(a) which re fer s to “pay ments . . . under [Title I I ],” the court re fuses that invit a tio n. To a c c e pt i t w ou ld b e to d ivo rc e § 4 04 (b ) f ro m § 4 04 (a ) a

nd in d oin g so contravene the canon of

statutory construction that “a

statute is to be rea d as a whole,” see King v. St. Vincent's Hosp. , 502 U.S. 215, 221 (1991), espe cially wher e construingadjac ent subsections with remar

kably simil ar struc tures, see U

nited States v. Atl. Researc h Corp. , 551 U.S. 128, [ 2336] (2007). B eca

use the c ourt finds that § 404(b) a pplies only

to pay ments under Title I I , the cour t cannot sustain Plaintiffs’ conte ntion that they are entitled to seek a

waiver of re cover

y for the
e r r o n e o u s P artD p r e m i u mr e f un d s th e y r e c e i v e d un d e r T i t l e X V III
. Th e c ourt a lso re je c ts Pl a int if

fs ’ e ff or t to br ingPart

D p re mium r e fu

nd s w ith in t

he g ambi t of Title I Iand thus within the scope of § 404(b) by

arguing that the ref

unds must have bee n de bit e d f ro m T itl e I Ifu

nd s c on sid e ri ngthat th e Se c re tary a lr e a dy ha d p a id t

he pr e miums t o p ri vate ins ur e rs . A lth ou g h th e pa rt ie s e xpe nd

muc h e ff or t tr a c ingthe so ur c e of

the e rr on e ou sly -p a id funds in distinguishing be tween a n “over pay ment” and a

“pre mium refund,” the source of the funds has no be aringon the cour t’s deter mination because the statute does not conte mplate the prec ise source of the funds a s beingindicative of le g al rig hts. The er roneous r efunds we re distributed under the a

uthority of Title XVI I I , which g overns Me dicar e programs administere d byTh e c ourt re a c he s th is c on c lus ion

no tw ith sta

nd ingits pr e vio us ob se rv a tio n th a t th e POM S 6 modeled its waiver

for Me dicar e Parts A a

nd B on the g ener al waive r provision in § 404(b), see Action Alliance I

, 456 F. Supp. 2d at 18, and notwithstandingits previous holding that Plaintiffs de mon str a te d a

su bs tanti a l li ke lih oo d o f s uc c e ss o n th e me ri ts o f t he ir c la im that th e POM S waiver extends to P art D, see id. at 23. Althoug h both this court and the D.C. Circuit observe d that the POMS waiver wa s modeled af ter § 404(b) , neither c ourt held that the POMS waiver was authorized by

§ 404(b) nor

that plaintiffs wer e entitled to see k a wa iver unde r § 404(b)
. See Action Alliance II

, 4 83 F .3 d at 85 5; Action Alliance I , 456 F. Supp. 2d at 18. 13 HHS, see42 U.S.C. §§ 1395-1395hhh, independently of the SSA, se e id . §§ 901 et seq. , and pr ov ide s th e statut or

y a uth or ity fo r t he SSAto d e du c t Pa

rt D p re miums f

ro m So c ia l Se c ur ity benef its, id. § 1395w-113(c )(1) (incorpor ating by ref ere nce id. § 1395w-24(d) (2)( A)). E ven if the
e rr on e ou s Pa

rt D r e fu nd s w e re ma de fr om T itl e I Ifu nd s, the SSAma de the m un de r t he a uth or ity of Title XVI I I , not Title I I ; thus, they fall outside the scope of § 404(b)
. 6 Be cause the cour

t finds that “the intent of Cong ress is clea r, that is the end of

the matter.” Chevron , 467 U.S. at 842. Acc ording ly , the cour t need not proc eed to the se cond step of the Chevron analy sis nor need it consider Plaintiffs’ arguments based on the C.F .R. or the POMS. F ina lly , th e c ourt

re je c ts Pl a int if

fs ’ c la im that D e fe nd ants vio late d D ue Pr oc e ss b y fa ili ngto provide the Me dicar e Participa nts with noti ce of

their wa iver right beca

use Plaintiffs can ide ntify no protec ted liberty

or prope rty

interest stemming from the putative w aiver rig ht consideringthe
c ourt ’s ho ldi ngthat th e Me dic are Part ic ipa nts have no ri g ht t o s e e k a § 4 04 (b ) w a ive r i n th e fi rs t place
.14 III . C ON CL USI ON F or the fo re g oin g re a so ns , D e fe nd ants ’ m oti on to d ism iss [#49 ] is G RA NT ED , and Pla int if fs ’ m oti on

fo r s umm ary

jud g me nt [# 50 ] is DE NI ED . An appr opriate or der a ccompa nies this Memorandum Opinion.

Henr y H. Kenne dy , J r. Un i t edS t at es Di s tri ctJ u d ge