Marietta Memorial Hosp. v. Davita Inc. (20-1641)
argument 20-1641Marietta Memorial Hosp. v. Davita Inc.
Supreme Court of the United States
1h 27m
6 speakers
8 chapters
transcribed 7 days ago
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Transcript
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What is the Medicare Secondary Payer Act and how does it apply to dialysis benefits?
We will hear argument next in case twenty sixteen forty one, Marietta Memorial Hospital, Employee Health Benefit Plan versus Davida Incorporated. Mr. Kulowitz?
Mr Chief Justice, and may I please the court For four decades the Medicare Secondary Payer Act has been a coordination of benefits statute It establishes that a group health plan must pay its benefits first during a thirty month coordination period when the plan and Medicare both cover an individual who must contend with end stage renal disease. The plan must not take into account the Medicare entitlement or eligibility of an individual during that time or differentiate in the benefits that it provides between individuals with end stage immunal disease and other individuals covered by the plan on a basis that relates to that diagnosis. The Sixth Circuit has determined that there also is an implied mandate that dialysis providers occupy a specific position to be determined relative to providers who serve other vital health care needs of the one hundred and fifty seven million American people who depend upon group health plans
to defray the costs of their health care. When Congress requires a specific benefit or parity between benefits, it does so directly. It did not do that here. The Medicare Secondary Payer Act coordinates benefits, it does not prescribe them. The plan at issue in this case provides the same benefits uniformly to all participants and as primary payer during the thirty month coordination period. Respondents failed to state a claim under the Medicare Secondary Payer Act. Because the alleged violations of the Medicare Secondary Payer Act are the express and only basis of their ERISA claims, respondents also fail to state a claim under ERISA. The court should reverse the Sixth Circuit and enter final judgment in favour of petitioners on all remaining claims.
I welcome the questions of the Court.
Uh Doesn't your approach permit uh the um uh differentiation or some differentiation between sort of high cost services that are used by a certain uh segment of the population. Uh I think that's the argument here that you have a lot of people who are uh not uh in a good position to pay who are being charged at a an uh an amount that uh they're high usage, they're poor, and they can't pay the costs and it seems as though your approach target that group.
Your Honor, the uh the approach that this plan takes is actually to minimize the actual out-of-pocket payment that the participants in any situation who are receiving dialysis will make. What this plan does by by tying the benefit by making the allowable charge uh the Medicare base rate and paying at one hundred and twenty-five percent of that, that means that the plan pays seventy percent and the individual pays thirty percent. So what's
the disagreement? The uh respondent does not agree with that assessment of the approach.
Yes, Your Honor, that's correct. The what the respondent uh seeks in paragraph sixty seven of its complaint and amended complaint on pages thirty two and three twenty two of the uh respective appendices is is that they have a right to be taid under the Medicare Secondary Payer Act their full undiscounted charges, because that is the only way to eliminate the the specter that they uh hang out there of balanced billing. But what that would mean for the participant is a participant who has been paying the uh thirty percent of 125 percent of the Medicare rate, which is uh $257 this year. So the the participant will be paying roughly $96 per treatment. Um but if the the court grants the relief ultimately that the Vita seeks, that same uh individual will be paying thirty percent of according to the Pacific Health Coalition Amicus Brief, the dialysis charges range from $1,041 to $6,000 per year.
per treatment. So that same participant, instead of paying $96 per treatment, will be paying up to up to uh eighteen hundred dollars per treatment. Thank you. Thank you, Honor.
Just a factual question. Is Marietta Uh Memorial Hospital. One hospital, like one big set of buildings.
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Chapters
8 chapters
1
What is the Medicare Secondary Payer Act and how does it apply to dialysis benefits?
0:00–10:22
2
How does the petitioner's plan structure payments for outpatient dialysis versus other services?
10:22–20:04
3
Why do the parties argue about “proxy” discrimination and what examples are used?
20:04–30:08
4
What are the key differences between the Sixth Circuit and Ninth Circuit interpretations?
30:08–39:18
5
How could a ruling in favor of Davita affect patients’ out‑of‑pocket costs?
39:18–52:06
6
What policy concerns do the Justices raise about Medicare’s fiscal impact?
52:06–1:04:32
7
How might the Court’s decision influence the availability of in‑network dialysis providers?
1:04:32–1:17:15
8
What are the broader implications of this case for ERISA and anti‑discrimination statutes?
1:17:15–1:27:51