Sullivan v. EverhartSullivan v. Everhart
Lead Opinion
delivered the opinion of the Court.
If the Secretary of Health and Human Services determines that & beneficiary has received “more or less than the correct
I
Two statutory benefit programs established by the Social Security Act (Act) are involved: the Old-Age, Survivors, and Disability Insurance program (OASDI), 53 Stat. 1362, as amended,
“Whenever the Secretary finds that more or less than the correct amount of payment has been made to any person under this subchapter, proper adjustment or recovery shall be made, under regulations prescribed by the Secretary, as follows:
“(A) With respect to payment to a person of more than the correct amount, the Secretary shall decrease any payment under this subchapter to which such overpaid person is entitled, or shall require such overpaid person or his estate to refund the amount in excess of the correct amount, or shall decrease any payment under this subchapter payable to his estate or to any other person on the basis of the wages and self-employment income which were the basis of the payments to such overpaid person, or shall apply any combination of the foregoing. . . .
“(B) With respect to payment to a person of less than the correct amount, the Secretary shall make payment of the balance of the amount due such underpaid person . . . Act §§ 204(a)(1)(A), (B);42 U. S. C. §§404(a)(1)(A) , (B) (1982 ed., Supp. V).
As to overpayments, the Act provides:
“In any case in which more than the correct amount of payment has been made, there shall be no adjustment of payments to, or recovery by the United States from, any person who is without fault if such adjustment or recovery would defeat the purpose of this subchapter or would be against equity and good conscience.” Act § 204(b);42 U. S. C. § 404(b) (1982 ed.).
The provisions regulating payment errors in the SSI program are substantially similar.
In the provisions set forth above, the Act contemplates that the Secretary will “fin[d] [whether] more or less than the correct amount” of payment has been made. Elsewhere, it confers upon the Secretary general authority to “make rules and regulations and to establish procedures, not inconsistent with the provisions of this subchapter, which are necessary or appropriate to carry out such provisions,” Act § 205(a),
“The amount of an underpayment or overpayment is the difference between the amount paid to a recipient and the amount of payment actually due such recipient for a given period. An overpayment or underpayment period begins with the first month for which there is a difference between the amount paid and the amount actually due for that month. The period ends with the month the initial determination of overpayment or underpayment is made.”20 CFR §416.538 (1989).
The OASDI regulation unhelpfully provides that “[t]he amount of an overpayment or underpayment is the difference between the amount paid to the beneficiary and the amount of the payment to which the beneficiary was actually entitled,”
Two hypotheticals will illustrate the operation of the netting regulations. Mr. A, entitled to $100 per month, is erroneously paid $80 in January and erroneously paid $150 in February. In March, the Secretary determines that these payments were incorrect, nets the errors (i. e., calculates the difference between the underpayment and the overpayment),
In the present case, the Secretary made both underpayments and overpayments to each of the respondents, and netted those errors pursuant to the regulations. He determined that three respondents (the original plaintiffs) received net underpayments, and paid that net amount. The other respondents (intervenors below) received net overpayments, and the Secretary offered them hearings to determine whether recoupment should be waived as to the net overpayment. The plaintiffs (later joined by the intervenors) filed this suit under §§ 205(g) and 1631(c)(3) of the Act,
We granted certiorari.
II
Our mode of reviewing challenges to an agency’s interpretation of its governing statute is well established: We first
A
We first consider whether the Act speaks directly to the validity of the netting regulations. Two provisions are relevant: a general authorization and a specific limitation. First, the Act authorizes the Secretary to determine whether “more or less than the correct amount” has been paid.
The fuller context of the OASDI provisions suggests that Congress, in authorizing the Secretary to determine whether the “correct amount” was paid, did not prohibit him from making that determination for more than a monthly time period. The Act authorizes a determination of whether “the correct amount of payment has been made,”
The Act’s provisions governing SSI are slightly different, but in no way contradict the Secretary’s position. They au
Respondents nevertheless maintain, as did the Court of Appeals, that another provision of the Act directly precludes the Secretary from netting underpayments and overpayments. They point to § 204(b),
In our view, however, with this provision as with those discussed earlier, respondents have established at most that the language may bear the interpretation they desire — not that it
As used in the Act, therefore, adjustment can be read to mean decreasing future payments, and recovery to mean obtaining a refund from the beneficiary. Under this interpretation, when the agency nets Mr. A’s underpayment against his overpayment, it is not engaged in “adjustment or recovery,” but only in the calculation of whether “more or less than the correct amount of payment has been made.” Only after making that calculation does the Secretary take the additional step of rectifying any error by “adjustment” (increas
B
Since the Act reasonably bears the Secretary’s interpretation that netting is permitted, only one issue remains: Respondents contend that the manner in which the regulations provide for netting to be conducted is arbitrary and capricious, because of their definition of the netting period. Overpayments are netted with underpayments up to the “month [of] the initial determination” of error.
It seems to us not arbitrary or capricious to establish a grace period within which these determinations can be considered and formally made; they should not be spur-of-the-moment decisions. That delay will extend the netting period, and may result in the inclusion of more underpayments to be netted. But we cannot say that the alternatives — immediate determinations, or determinations within a fixed period — would not produce errors that make beneficiaries worse off on the whole.
“Where an apparent overpayment has been detected but determination of the overpayment has not been made (see § 416.558(a)), a determination and payment of an underpayment which is otherwise due cannot be delayed unless a determination with respect to the apparent overpayment can be made before the close of the month following the month in which the underpaid amount was discovered.”20 CFR §416.538 (1989).
See also Dept, of Health and Human Services, Program Operations Manual System, GN 02201.002 (1989) (Social Security Administration policy to resolve overpayments as quickly as possible). Respondents’ fear of intentional manipulation of the netting period can be entirely dismissed if this provision is observed in good faith — as we must presume, in this facial challenge, it will be. See, e. g., FCC v. Schreiber,
In addition to the fact that the disadvantages of the Secretary’s approach are less than respondents assert, the disadvantages of respondents’ approach are more. The Secretary points out that a separate accounting for each month would cause the agency great expense, in the cost of a greatly in
Respondents seek to minimize the administrative burden by proposing a scheme under which the Secretary would notify the beneficiary of underpayments and overpayments, withhold reimbursement of the underpayments for a brief period during which the beneficiary may seek waiver of recoupment of overpayments, and then net the underpayments and that portion of the overpayments as to which waiver has not been sought. This scheme, however, does not at all address the problem of delay in netting that is the asserted basis for finding the regulations arbitrary and capricious. Substituting “notification” of underpayments and overpayments for “determination” of underpayments and overpayments merely gives the occasion for the delay another name. What this alternative proposal of respondents really puts forward is an alternative means of assuring that overpayments cannot be “netted out” without an opportunity for waiver hearing. As we discussed at length earlier, the statute does not require such assurance. In sum, we find no basis for holding the regulations arbitrary and capricious.
* * *
The Court of Appeals did not reach respondents’ contention that the regulations violate due process, and we will not address that claim in the first instance. See, e. g., United States v. Sperry Corp.,
It is so ordered.
Notes
“(A) Whenever the Secretary finds that more or less than the correct amount of benefits has been paid with respect to any individual, proper adjustment or recovery shall, subject to the succeeding provisions of this subsection, be made by appropriate adjustments in future payments to such individual or by recovery from such individual or his eligible spouse (or from the estate of either) or by payment to such individual or his eligible spouse ....
“(B) The Secretary (i) shall make such provision as he finds appropriate in the case of payment of more than the correct amount of benefits with respect to an individual with a view to avoiding penalizing such individual or his eligible spouse who was without fault in connection with the overpayment, if adjustment or recovery on account of such overpayment in such case would defeat the purposes of this subchapter, or be against equity and good conscience, or (because of the small amount involved) impede efficient or effective administration of this subchapter . . . .” Act §§ 1631(b)(1)(A), (B):
Dissenting Opinion
The kingly power to rewrite history has not been delegated to the Secretary of Health and Human Services. Nevertheless, the Secretary now claims authority to determine that no underpayment has been made to a beneficiary who concededly received a deficient monthly payment. The majority accepts this argument. Because I believe this result inconsistent with both common sense and the plain terms of the statute, I respectfully dissent.
The Social Security Act (Act),
In the vast majority of cases, these procedures are uncontroverted. We deal today only with a narrow category of disputed cases in which claimants assert rights designed to protect specially disadvantaged beneficiaries. Respondents, like the plaintiffs in Califano v. Yamasaki,
With respect to these beneficiaries, as in all other cases involving overpayments, Congress has given the Secretary explicit mandatory instructions. Those instructions require him to recognize that any case in which “more than the correct amount of payment has been made” involves a factual event that cannot be ignored. The Secretary cannot erase the historical record or pretend that the overpayment never occurred simply because later events alter the significance of earlier ones.
This is what the statutory command says about OASDI overpayments:
“In any case in which more than the correct amount of payment has been made, there shall be no adjustment of payments to, or recovery by the United States from, any person who is without fault if such adjustment or recovery would defeat the purpose of this subchapter or would be against equity and good conscience.” § 204(b) of the Act; 42 U. S. C. § 404(b) (1982 ed.).
We have previously recognized that this provision “concerning the fact of the overpayment” speaks in “the imperative voice” and requires that “‘there shall be no adjustment of payments to, or recovery by the United States from, any person’ who qualifies for waiver.” Califano v. Yamasaki,
As the Court of Appeals for the Tenth Circuit observed, by this provision and its SSI counterpart the “statute makes a clear differentiation” between overpayments and underpayments. Everhart v. Bowen,
If we use two typical cases involving a $500 overpayment as examples, we can readily see how the Secretary’s “netting regulations” violate the statutory command. In the first example, we may assume that the $500 overpayment was made in 1978 and first discovered in 1988. If we further assume that the beneficiary was without fault and that it would have been against equity and good conscience to recoup that amount from him in 1988, it necessarily follows that he had a statutory right to a waiver of any such recoupment. In our second hypothetical example, we may assume the same facts with the addition that in 1988 the beneficiary’s monthly checks were erroneously reduced by $250 for each of two months. Under the Secretary’s reading of the statute, the beneficiary’s request for payment of the balance of the amount due for those two months could be denied on the ground that neither more nor less than the correct amount of payment had been made during the period between 1978 and 1988.
In my view such a reading of the statute is intolerable. The assumption that an underpayment in 1988 — whether negligent or deliberate — could extinguish a needy beneficiary’s statutory right to request a waiver of recoupment of an overpayment that occurred years earlier is flatly inconsistent with the statutory command that “equity and good conscience” should determine the waiver issue. For the Secretary to pretend that neither more nor less than the correct amount had been paid — when there was not only a series of
In light of the statistics quoted in Yamasaki,
For some beneficiaries the amount at stake is substantial, and the reasons why Congress commanded the Secretary to carefully consider the equities of the particular case are overwhelmingly apparent. Thus, for example, respondent Emil Zwiezen and his wife are both dependent on their monthly Social Security checks of $911. According to the Secretary, Mr. Zwiezen received $9,483 in overpayments between 1978 and 1981. The Secretary, however, failed to give Mr. Zwiezen certain increases in his monthly benefit amount to which he was entitled and, by April 1984, he had accumulated underpayments of $4,376. Although he ultimately received a waiver of the net overpayment remaining after the Secretary subtracted the underpayments, Mr. Zwiezen never had
The validity of the netting regulations that enabled the Secretary to recover $4,376 from Mr. Zwiezen without giving him the notice and opportunity to request a waiver required by § 204(b) depends on a highly unnatural reading of three statutory provisions. First, the Secretary assumes that no overpayment or underpayment can actually occur until he finds that it has occurred. This assumption is not only foreclosed by the plain language of § 204(b) and § 1631 (b)(l)(B)(i),
Second, the Secretary assumes that the words “adjustment” and “recovery” in the two prohibitions against inequitable recoupment of overpayments do not apply to either a deliberate or an inadvertent decrease in monthly payments unless the Secretary has previously made a formal finding that an overpayment occurred. As a practical matter this means that either a simple mistake or a deliberate effort to
Finally, in a statutory scheme that is replete with references to monthly payments and monthly benefits,
Indeed, Califano v. Yamasaki,
In this case it is clear beyond peradventure that Congress intended to ensure that needy citizens would receive their full monthly benefit checks, even if that policy sometimes means forgoing any opportunity the Government might have to recoup an earlier overpayment. The Secretary’s reading of the statute puts an unreasonable strain upon both its words and its purpose. If context were ignored entirely, I suppose that a student of language could justify the Secretary’s interpretation of “adjustment” and “payment,” and his duty to find historical facts. Perhaps that is what the majority means when it says that the statutory language “reason
I respectfully dissent.
The Secretary’s argument becomes especially weak if this subset is very large. If the- Secretary can evade the waiver provisions by netting overpayments against underpayments, and if netting is possible in most eases, then the Secretary’s procedures would effectively nullify the waiver provisions. Such a consequence would be strong evidence that the Secretary’s procedures are inconsistent with the statute. See, e. g., Colautti v. Franklin,
SSI overpayments subject the Secretary to a similar command. Section 1631(b)(l)(B)(i) of the Act,
The OASDI provision reads: “In any case in which more than the correct amount of payment has been made, there shall be no adjustment. . . .”
Likewise,
The majority speculates that “[djeliberately protracting the netting period may indeed draw in future underpayments; but it may just as likely draw in future overpayments, which will be uncollectible until the Secretary’s determination is made." Ante, at 94. This proposition depends, of course, upon the relative frequency of overpayments and underpayments. The majority assumes that the two occur with equal frequency, an assumption for which it offers no support. One might indeed make precisely the opposite assumption: that the Government errs in its own favor more often, and more substantially, than it errs in favor of beneficiaries.
See, e. g.,
It is, of course, of no importance that Yamasaki predates Chevron U. S. A. Inc. v. Natural Resources Defense. Council, Inc.,
Even this much is far from clear. The majority’s suggestion is that Congress could have referred to individual monthly payments, rather than a net transfer, by using the phrase “any payment,” rather than simply “payment,” in, for example,
For reasons already stated, I do not believe that this provision is ambiguous. But if it were, the majority’s suggestion would not dispell entirely the interpretive difficulties that trouble the majority. The word “payment” embraces two concepts: that of a wealth transfer, and that of a transaction used to effect such a transfer. For this reason, it is possible for a lender to tell a borrower that “a series of 15 payments will be needed to effect payment of the debt.” By using the plural form of “payment,” the lender focuses attention upon several transactions, rather than the transfer accomplished by the transactions together. And, indeed, careful examination of the statute, the majority opinion, and this dissent will show that all three frequently distinguish transactions from transfer by invoking the plural, “payments.”
The majority wisely declines to suggest that Congress should have used the plural in
As already noted, the majority proposes to solve this problem by inserting the word “any" before “payment.” But the adjective begs the ques
The Congress which the majority imagines would thus have to search for other means to express its intent. One possible attempt is actually in the statute. Congress uses the awkward phrase, “correct amount of payment has been made.” The educated layman may cringe on hearing this legalism; “correct amount has been paid” seems to say as much and more crisply. Why add the bulky “of payment”? It is at least possible that Congress hoped to focus attention on individual payments: the “of payment” reminds the reader that “amounts” due are not simply due in total, but due in regular installments — denominated “payments.” This point is obviously not dispositive, but it is more plausible than the majority’s discussion of “any payment.”
Of course, Congress could have obviated the need for any such analysis by inserting into the statute a reference to payments in individual months, or simply by saying: “The Secretary shall not net underpayments and over-payments.” My point is not that a more precise statute is impossible, however; my point is only that the interpretive difficulties posed by the statute cannot reasonably be ascribed to a conscious delegation, to the absence of intent, or to inability to forge a coalition. See Chevron,
See Yamasaki,
In Yamasaki, for example, we interpreted the statute to confer a hearing right, even though Congress never used the word “hearing.” One might argue that if Congress wished to establish a hearing right, “it would be more natural” for Congress to draft a statute that mentioned hearings expressly. The Yamasaki Court supplied the proper answer to this objection: whether or not reference to hearings would be more natural, it is unnecessary, since the hearing right inheres in “the nature of the statutory standards.” Id., at 693.