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Supreme Court rules against DaVita and in favor of health plan


DaVita claims Marietta Memorial Hospital Employee Health Benefit Plan’s limited coverage for outpatient dialysis violates the statute.

In a 7-2 decision, the Supreme Court has sided with a health plan over its coverage for outpatient dialysis services.

Major dialysis service provider DaVita had sued the Marietta Memorial Hospital Employee Health Benefit Plan claiming its limited coverage violated the statute.

The Justices ruled against DaVita , in an opinion released Tuesday. Justice Brett Kavanaugh delivered the opinion of the Court, in which Chief Justice John Roberts and Justices Clarence Thomas, Stephen Breyer, Samuel Alito, Neil Gorsuch and Amy Coney Barrett joined. Justice Elena Kagan filed an opinion dissenting, in part, in which Justice Sonia Sotomayor joined.

Justice Kavanaugh said the question was whether a group health plan that provides limited benefits for outpatient dialysis — but does so uniformly for all plan participants –violates the Medicare Secondary Payer statute.

“We agree with petitioner Marietta and the United States as amicus curiae that the answer is no,” Kavanaugh wrote. “We therefore reverse the judgment of the U. S. Court of Appeals for the Sixth Circuit and remand the case for further proceedings consistent with this opinion.” WHY THIS MATTERS DaVita is a major dialysis […]

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