In the 

United States Court of Appeals 

For the Seventh Circuit ____________________ 

No. 20-1268 

MAO-MSO RECOVERY II, LLC; MSP RECOVERY, LLC; MSPA

CLAIMS 1, LLC; and MSP RECOVERY CLAIMS SERIES LLC, 

Plaintiffs-Appellants, 

v.

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, an 

Illinois Company, 

Defendant-Appellee. 

____________________ 

Appeal from the United States District Court for the 

Central District of Illinois. 

No. 1:17-cv-01537 — Joe Billy McDade, Judge. 

____________________ 

ARGUED NOVEMBER 5, 2020 — DECIDED APRIL 20, 2021 

____________________ 

Before SYKES, Chief Judge, and HAMILTON and SCUDDER,

Circuit Judges. 

SCUDDER, Circuit Judge. For the second time in as many 

years we affirm the district court’s dismissal of a lawsuit 

brought under the Medicare Act by entities seeking to collect 

on healthcare receivables assigned to them by so-called Medicare Advantage Organizations. The Medicare Act may 
2 No. 20-1268 

authorize the lawsuit but, regardless, the district court rightly 

recognized that identifying a federal cause of action satisfies 

only half of the inquiry necessary to establish subject matter 

jurisdiction. The half left unsatisfied is Article III standing—

the same shortcoming that resulted in the dismissal of the 

analogous lawsuit two years ago. Despite ample opportunity, 

the plaintiffs once again were unable to show any injury in 

fact. They failed to find within their basket of assigned receivables an example of a concrete and definite amount owed 

them by the defendant, State Farm Mutual Automobile Insurance Company. In affirming, we sound a word of caution. 

This lawsuit mirrors scores like it filed in federal courts 

throughout the country that have all the earmarks of abusive 

litigation and indeed have drawn intense criticism from many 

a federal judge. The plaintiffs should think hard before risking a third strike within our Circuit. 

I 

A 

The Medicare Act is as unwieldy and complex as any statute in the U.S. Code. This appeal, fortunately, does not immerse us in the interpretive morasses that often define Medicare appeals. What is important here is understanding some 

basic points about the flow of Medicare payment obligations 

and the distinction between primary and secondary payers 

under the program. 

Congress divided the Medicare Act into so-called parts. 

Part C of the Act allows private entities to provide insurance 

coverage for some Medicare enrollees. See 42 U.S.C. 

§ 1395w-21(a). These private entities are known as Medicare 

Advantage Organizations or MAOs. See id. Just like the 
No. 20-1268 3

Medicare program itself, these MAOs act as secondary payers 

in situations where another insurer—for example, a worker’s 

compensation plan or automobile insurer—is also responsible 

for paying for medical care. See id. §§ 1395y(b)(2)(A)(ii); 

1395w-22(a)(4). These other insurers are known as primary 

payers. 

A simple example illustrates this point. Suppose a driver 

is injured in a car accident. Assume the driver has a car insurance policy with a $10,000 limit for medical bills associated 

with an accident and, separately, has coverage from an MAO 

through Medicare Part C. In an ideal world, the driver’s car 

insurance would cover the first $10,000 in medical expenses 

with the MAO picking up the rest. 

The real world, of course, is not always ideal, and primary 

payers do not always pay (or timely pay) covered medical expenses. The Medicare Act recognizes this reality and allows 

an MAO (as a secondary payer) to make “conditional payments” if the primary payer “has not made or cannot reasonably be expected to make payment with respect to such item 

or service promptly.” Id. § 1395y(b)(2)(B). If an MAO makes 

such a conditional payment, the Act in turn creates a private 

right of action allowing the MAO to seek reimbursement from 

the primary payer who should have made payment in the first 

place. See id. § 1395y(b)(3)(A). Importantly, this private right 

of action allows an MAO to recover double damages for any 

unreimbursed conditional payment. See id.

B 

Because of the ubiquity of insurance in the modern economy, people often have overlapping coverage through both a 

primary payer and an MAO. As a result, MAOs sometimes 
4 No. 20-1268 

make conditional payments with insufficient knowledge 

about the responsible primary payer. If an MAO later learns 

that a primary payer shouldered principal responsibility for a 

particular covered expense, the organization is able to seek 

reimbursement from the primary payer. But trying to collect 

these unreimbursed payments can be tedious, costly, and uncertain. This creates an incentive for MAOs to outsource this 

process—essentially to assign or sell its right to reimbursement to another party. 

On the demand side, entities like the plaintiffs here see financial opportunity in effectively becoming debt collectors 

for MAOs. This arrangement can be lucrative because of the 

Medicare Act’s double damages provision. If debt collectors—or more accurately assignees of the MAO—can identify 

unreimbursed conditional payments and successfully bring 

suit under the Act, they can collect twice as much on a particular assigned receivable. But again, because it is not always 

clear which assigned receivables in fact reflect conditional 

payments, taking on this debt collection role brings with it financial uncertainty. And, just like the MAOs, a third-party assignee may not know at the time of the initial assignment 

which or how many conditional payments should actually be 

reimbursed by a primary payer. 

Note the financial realities that exist for the debt collectors 

and MAOs alike. Both have financial incentives to expend as 

little as possible on the front end of these assignment arrangements. This is so because it is often unclear at the time of the 

initial assignment what, if any, value exists in the assigned receivables. 

We see this reality play out in the assignment contracts in 

the record before us in the following way: MAOs agree to 
No. 20-1268 5

assign their collection rights to large baskets of potential conditional payments in exchange for a percentage of anything 

recovered. For their part, the debt collectors agree to this fee 

sharing arrangement but do not pay much, if anything, up 

front for the assignation of collection rights. It is then on the 

assignee—effectively the debt collector—to do its best to collect and thereby realize value on the assignment. If the assignee is successful in recovering double damages through litigation, there is sufficient revenue to make the litigation and 

collection effort worth the collector’s while, with proceeds remaining to share with the MAO. If nothing is recovered, the 

assignee loses only its litigation costs. 

C 

With this basic backdrop in place, we turn to the litigation 

at hand. The plaintiff debt collectors in this case (whom we 

refer to collectively as “MAO-MSO”) are various entities who 

have entered into assignment contracts with MAOs and acquired rights to collect conditional payments. Because of the 

nature of the market we just described, these assignee debt 

collectors had little incentive to perform any diligence on the 

front end of these transactions to verify the value of what they 

may have received in the assignment. And indeed MAO-MSO 

do not appear to have done so with any of the assignments at 

issue. 

The lack of front-end diligence had a consequence: MAOMSO found themselves unable in the district court to do more 

than show an assigned right to recover potentially unreimbursed payments. Put another way, they could identify baskets of possible receivables arising from payments MAOs 

made for healthcare provided to someone enrolled in Medicare but could go no further. They instead sought to use the 
6 No. 20-1268 

litigation process itself (in particular, discovery) as their pathway to identifying any value in the assigned receivables and 

then pursuing any available collections. 

The district court demanded more. In order to show an actual injury—a necessary element of Article III standing—the 

district court required the MAO-MSO plaintiffs to identify 

something of value from within the basket of unidentified assignments. Even more specifically, MAO-MSO needed to 

point to an “illustrative beneficiary”—that is, to a concrete example of a conditional payment that State Farm, the relevant 

primary payer here, failed to reimburse to the pertinent MAO. 

The plaintiffs responded by filing an amended complaint 

and alleging examples of particular unreimbursed conditional payments. On their third try they named a specific illustrative beneficiary identified by the initials “O.D.” MAOMSO outlined the injuries O.D. allegedly suffered in a car accident and contended that she “incurred accident-related expenses that were to be paid by [State Farm]” pursuant to an 

auto insurance policy, but for which State Farm “failed to adequately pay or reimburse” the appropriate MAO. 

The district court determined that these allegations sufficed for pleading purposes to establish standing, so the litigation moved forward. Everything changed at summary 

judgment, however. 

As the limited discovery process authorized by a magistrate judge progressed, MAO-MSO struggled to identify evidence supporting the allegations of financial injury in their 

complaint. The ensuing dispute centered on whether O.D.’s 

MAO made payments related to medical care stemming from 

a car accident before State Farm reached its limit under O.D.’s 
No. 20-1268 7

auto policy. If so, then State Farm, as the primary payer, 

should have reimbursed the MAO, and its failure to do so 

would create an actionable injury. The specific payment in 

question was to a physical therapist. MAO-MSO’s complaint 

alleged this payment was for treatment stemming from O.D.’s 

car accident, and therefore should have been paid by State 

Farm under O.D.’s auto policy. State Farm disagreed, explaining that the physical therapy services had no connection to 

O.D.’s car accident and instead related only to her efforts to 

recover from her prior knee surgery. 

The district court framed the inquiry in terms of Article III 

standing: if the medical evidence allowed a finding that the 

physical therapy payment in question related to O.D.’s car accident—instead of the knee surgery—then MAO-MSO would 

have made the showing necessary at summary judgment to 

establish standing. After taking a close look at the record, the 

district court determined that MAO-MSO had not met their 

burden because no reasonable jury could find that the payment in question related to O.D.’s car accident. The absence 

of a concrete injury meant that MAO-MSO lacked standing, 

so the district court entered summary judgment for State 

Farm. 

The MAO-MSO entities now appeal. They challenge the 

entry of summary judgment for State Farm as well as the district court’s denial of requests to stay the summary judgment 

ruling pending additional discovery and, separately, for permission to file a third amended complaint. 

II 

We encountered a very similar appeal involving these 

same parties two years ago. See MAO-MSO Recovery II, LLC v. 
8 No. 20-1268 

State Farm Mut. Auto. Ins. Co., 935 F.3d 573 (7th Cir. 2019) 

(“MAO-MSO I”). In MAO-MSO I, these same plaintiffs sought 

damages related to allegedly unreimbursed payments that 

State Farm should have made pursuant to personal injury policies (instead of the no-fault auto policies at issue here). See 

935 F.3d at 577. The district court dismissed MAO-MSO I for 

lack of standing, and we affirmed. There, as here, the district 

court required the plaintiffs to identify specific examples of 

unreimbursed payments—the so-called illustrative beneficiaries—to demonstrate the existence of an actual injury and 

thus the Article III standing necessary to establish subject matter jurisdiction. In affirming, we determined that the district 

court’s analysis was spot-on: because the assignment covering 

the illustrative beneficiary presented in that case was invalid, 

the plaintiffs did not establish standing. Id. at 580–81. 

The district court charted the same analytical course here, 

and we once again affirm. 

A 

Whether MAO-MSO have standing turns on two questions. First, we must consider whether the district court correctly demanded a showing of at least one illustrative beneficiary. Second, if such a showing was necessary, we need to 

assess whether the plaintiffs supported their illustrative beneficiary allegations with enough evidence to show a concrete 

and particularized injury. The district court was right to find 

that MAO-MSO once again failed to meet this burden. 

“[N]o principle is more fundamental to the judiciary’s 

proper role in our system of government than the constitutional limitation of federal-court jurisdiction to actual cases or 

controversies.” Spokeo, Inc. v. Robins, 136 S. Ct. 1540, 1547 
No. 20-1268 9

(2016) (quoting Raines v. Byrd, 521 U.S. 811, 818 (1997)). The 

familiar test for Article III standing requires a plaintiff to show 

an injury. See Friends of the Earth, Inc. v. Laidlaw Env’t Servs. 

(TOC), Inc., 528 U.S. 167, 180–81 (2000). And the Supreme 

Court has made clear that the elements of standing are “not 

mere pleading requirements but rather an indispensable part 

of the plaintiff’s case [which] must be supported in the same 

way as any other matter on which the plaintiff bears the burden of proof, i.e., with the manner and degree of evidence required at the successive stages of the litigation.” Lujan v. Defs. 

of Wildlife, 504 U.S. 555, 561 (1992). 

Because the cause of action here is a statutory claim for the 

collection of unreimbursed payments, MAO-MSO’s injury 

has to be the existence of an unreimbursed payment—a concrete right to collect from State Farm—not the mere existence 

of an assignment to collect potentially unreimbursed payments. If, for example, State Farm adhered to its obligations 

under an auto policy by fully paying particular medical expenses, any assigned rights to reimbursement would have no 

value, and MAO-MSO would have suffered no injury. Right 

to it, the district court correctly required MAO-MSO to identify at least one illustrative beneficiary for whom State Farm 

had failed to reimburse an MAO for medical expenses it paid 

in the first instance. 

MAO-MSO urge a different approach. For the first time on 

appeal MAO-MSO contend that they did not need to present 

an exemplar claim to establish standing at the summary judgment stage. Instead, they insist that standing requires no more 

than a showing of a valid assignment from an MAO to pursue 

reimbursement from a primary payer like State Farm. Not so 

in our view. 
10 No. 20-1268 

As an initial matter, MAO-MSO never made this argument 

in their summary judgment briefing in the district court, and 

so have waived it. See Perry v. Sullivan, 207 F.3d 379, 383 (7th 

Cir. 2000) (“Arguments raised for the first time on appeal are 

routinely deemed waived.”). But even if we entertain the contention, MAO-MSO’s position conflates whether the entities 

have a statutory private cause of action with the existence of 

an injury-in-fact. For purposes of establishing subject matter 

jurisdiction, the inquiries are distinct. Both Article III standing 

and a cause of action are necessary to establish a Case or Controversy over which we have jurisdiction. See Raines v. Byrd, 

521 U.S. 811, 820 n.3 (1997) (“It is settled that Congress cannot 

erase Article III’s standing requirements by statutorily granting the right to sue to a plaintiff who would not otherwise 

have standing.”). But neither showing alone is sufficient. 

That Congress created a cause of action and thereby authorized the enforcement of a particular right or pursuit of a 

certain remedy in federal court does not itself demonstrate the 

existence of a concrete and particularized injury. The Supreme Court underscored this precise point in Spokeo, explaining that “Congress’ role in identifying and elevating intangible harms does not mean that a plaintiff automatically 

satisfies the injury-in-fact requirement whenever a statute 

grants a person a statutory right and purports to authorize 

that person to sue to vindicate that right.” 136 S. Ct. at 1549. 

Congress can provide a cause of action, as it did here in Part 

C of the Medicare Act (see 42 U.S.C. § 1395y(b)(3)(A)), and 

that cause of action may be available to certain plaintiffs (although whether third-party assignees can invoke this particular cause of action remains an open question). But even a 

plaintiff seeking a congressionally authorized remedy must 

still show a concrete and particularized injury. 
No. 20-1268 11

The district court applied these well-established principles 

when it required MAO-MSO to support their allegations of a 

concrete, individualized injury through an illustrative beneficiary with evidence produced at summary judgment. 

B 

Answering whether O.D. was a proper illustrative beneficiary necessarily takes us into evidentiary details. And, in taking our own fresh look at the summary judgment record, we 

looked specifically at what the record shows about O.D.’s car 

accident and the surrounding medical treatment. 

O.D. underwent knee replacement surgery in June 2013. 

After the surgery she required physical therapy, and her therapist recommended twelve sessions over four weeks beginning on October 3, 2013. About two weeks after O.D. began 

the physical therapy, she got into a car accident. The accident 

occurred on October 15, 2013, at a time when O.D. had already attended two of the twelve therapy sessions. At the 

scene of the accident, O.D. reportedly told the EMT that she 

had a headache and pain in her left knee. O.D. conveyed the 

same information to the ER nurse at the hospital. 

The summary judgment record also contains notes from 

the doctor who treated O.D. at the hospital. Those notes make 

no mention of any knee injury or pain and only order tests 

related to O.D.’s cervical spine. Nowhere do the doctor’s 

notes say a word about O.D. needing any kind of knee treatment. 

The physical therapy that O.D. started before the car accident continued. The therapy treatment notes from the day after the car accident show that O.D. told her therapist that the 

accident did not affect her knee. Subsequent therapy notes 
12 No. 20-1268 

likewise say nothing about the accident and reflect no change 

in O.D.’s treatment after the accident. To the contrary, the 

physical therapist’s notes continued to list O.D.’s knee surgery as the “mechanism of injury.” 

The district court relied on this evidence in determining 

that no genuine dispute of material fact existed as to whether 

the physical therapy treatment was for O.D.’s car accident instead of her knee surgery. The district court concluded that 

no reasonable juror could find that State Farm, as O.D.’s auto 

insurer, was responsible for paying a physical therapist to rehabilitate O.D.’s knee after reconstructive surgery, when the 

surgery occurred four months before the car accident and no 

reliable evidence indicated that the car accident exacerbated 

any knee injury. 

MAO-MSO disagree, focusing on O.D.’s statements to the 

ER nurse that her knee hurt after the car accident. But MAOMSO entirely overlook their own procedural error in the district court. Even though placing great weight on the ER 

nurse’s notes, MAO-MSO failed to attach the notes to its summary judgment motion. We will not overlook the failing. Indeed, we have repeatedly held that it is not the responsibility 

of the district court to dig through the record to find evidentiary support for a party’s summary judgment arguments. See 

Grant v. Trustees of Indiana Univ., 870 F.3d 562, 568 (7th Cir. 

2017) (“As the put up or shut up moment in a lawsuit, summary judgment requires a non-moving party to respond to 

the moving party’s properly-supported motion by identifying 

specific, admissible evidence showing that there is a genuine 

dispute of material fact for trial.” (internal quotation marks 

and citation omitted)). The district court acted well within its 
No. 20-1268 13

discretion by declining to consider a document that was not 

properly before it at summary judgment. 

What is more, the fact that O.D. told an admitting nurse 

that she had knee pain is not evidence that her car accident 

caused that pain, let alone that subsequent physical therapy 

treatments were the result of or even related to the car accident. And that is especially so given the evidence, including 

the treating physician’s notes, pointing in a different direction. Summary judgment requires only that all reasonable inferences be drawn in favor of the non-moving party. See 

Poullard v. McDonald, 829 F.3d 844, 852 (7th Cir. 2016). An inference is not reasonable if it is directly contradicted by direct 

evidence provided at the summary judgment stage, nor is a 

“conceivable” inference necessarily reasonable at summary 

judgment. See Cont’l Casualty Co. v. Nw. Nat. Ins. Co., 427 F.3d 

1038, 1041 (7th Cir. 2005). 

Based on the record properly before the district court, we 

agree that no genuine dispute of material fact existed regarding allegedly unreimbursed payments for O.D.’s medical 

treatment. Because O.D. was the only illustrative beneficiary 

properly before the district court at summary judgment, 

MAO-MSO failed to identify a specific receivable they had 

been assigned from an MAO that State Farm, as the primary 

payer under an applicable auto policy, was required to pay. 

MAO-MSO thus did not show the type of concrete and particularized injury necessary to demonstrate standing. On this 

record, the district court correctly granted State Farm’s motion for summary judgment. 
14 No. 20-1268 

III 

We next consider two other rulings of the district court 

that MAO-MSO challenge on appeal. The district court denied MAO-MSO’s requests for a stay of summary judgment 

pending further discovery under Federal Rule of Civil Procedure 56(d) and for leave to file a third amended complaint. 

We see no error in either of these rulings. 

A 

We review the denial of a Rule 56(d) motion for abuse of 

discretion. See Arnold v. Villarreal, 853 F.3d 384, 389 (7th Cir. 

2019). “Rule 56 permits a district court to delay consideration 

of a summary judgment motion and order additional discovery before ruling if the non-movant demonstrates that ‘it cannot present facts essential to justify its opposition.’” Sterk v. 

Redbox Automated Retail, LLC, 770 F.3d 618, 627–28 (7th Cir. 

2014) (quoting FED. R. CIV. P. 56(d)). “The Rule places the burden on the non-movant that believes additional discovery is 

required to ‘state the reasons why the party cannot adequately respond to the summary judgment motion without 

further discovery.’” Id. at 628 (quoting Deere & Co. v. Ohio 

Gear, 462 F.3d 701, 706 (7th Cir. 2006)). Additionally, “[a] party 

seeking relief under Rule 56(d) must show by affidavit or declaration specific reasons discovery should be extended, which 

requires more than a fond hope that more fishing might net 

some good evidence.” Smith v. OSF HealthCare Sys., 933 F.3d 

859, 864 (7th Cir. 2019). 

The MAO-MSO entities did not meet their burdens. First, 

they once again waived part of their argument. MAO-MSO 

never objected to the magistrate judge’s discovery order. They 

cannot now use their appeal of a Rule 56(d) motion to 
No. 20-1268 15

challenge a scheduling order they never objected to in the first 

instance. See Pinkston v. Madry, 440 F.3d 879, 891 n.15 (7th Cir. 

2006) (“[B]ecause [Plaintiff] failed to object to the magistrate 

judge’s order prior to, during or after the hearing, the issue 

has been waived.”). 

Second, MAO-MSO failed to show why they needed additional discovery to oppose State Farm’s summary judgment 

motion. More to it, in opposing the motion, MAO-MSO identified three additional illustrative beneficiaries they posited 

could have established standing. But MAO-MSO knew of 

these beneficiaries from the moment they signed the relevant 

assignment agreement—years before State Farm filed its summary judgment motion—and indeed had previously pleaded 

facts related to these individuals in other litigation. Plain and 

simple, MAO-MSO had ample time to conduct non-party discovery to develop the evidence related to these claims but 

took no steps to do so. Nor did MAO-MSO send any discovery requests to State Farm related to these specific beneficiaries. The plaintiffs now say that State Farm was not responsive 

to the general discovery requests they did send during class 

discovery, but they never filed any motions to compel State 

Farm to respond to a single request. On this record, now is not 

the time to complain about what transpired during discovery. 

We see no abuse of discretion in the district court’s denial 

of MAO-MSO’s request to stay summary judgment under 

Rule 56(d). 

B 

Nor did the district court abuse its discretion in refusing 

to allow the MAO-MSO entities to file a third amended complaint. “We review a district court’s denial of leave to amend 
16 No. 20-1268 

for abuse of discretion and reverse only if no reasonable person could agree with that decision.” Schor v. City of Chicago, 

576 F.3d 775, 780 (7th Cir. 2009). Additionally, because MAOMSO filed their motion for leave well after the deadline to 

amend pleadings had passed, they must satisfy the “good 

cause” standard of Federal Rule of Civil Procedure 16(b)(4). 

(“A schedule may be modified only for good cause and with 

the judge’s consent.”). “Rule 16(b)’s ‘good cause’ standard 

primarily considers the diligence of the party seeking amendment.” Trustmark Ins. Co. v. Gen. & Cologne Life Re of Am., 

424 F.3d 542, 553 (7th Cir. 2005) (quoting Johnson v. Mammoth 

Recreations, Inc., 975 F.2d 604, 609 (9th Cir. 1992)). 

In an April 9, 2019 filing related to the enforcement of a 

protection order, MAO-MSO told the district court that they 

would “soon be moving to incorporate the [Florida] exemplar 

beneficiaries from [a recently dismissed] matter [in the Southern District of Florida] into the present one.” They even discussed the Florida illustrative beneficiaries in their motion for 

class certification. From there, however, MAO-MSO failed to 

seek leave to amend their complaint until October 2, 2019—

the day after they filed their response to State Farm’s summary judgment motion. This six-month delay does not reflect 

the level of diligence necessary to establish good cause. And 

the district court did not abuse its discretion by so finding. 

IV

We end where we began. This appeal, much like our 2019 

decision affirming the dismissal of a very similar lawsuit by 

the same parties, leaves us with the unmistakable impression 

that these debt collector plaintiffs pull the litigation trigger before doing their homework. They sue to collect on receivables 

they paid little or nothing for and then rely on the discovery 
No. 20-1268 17

process to show they acquired something of value and thus 

have an enforceable right to collect. This time around, at the 

critical put up or shut up moment of summary judgment, the 

plaintiffs once again failed to establish standing. 

Federal courts do not possess infinite patience, nor are the 

discovery tools of litigation meant to substitute for some modicum of pre-suit diligence. The plaintiffs’ approach is not sitting well with many judges, and multiple district courts have 

already commented on what they perceive as MAO-MSO’s 

rush to file litigation in the hope that discovery will show 

whether an actual case or controversy exists. See, e.g., MSP 

Recovery Claims, Series LLC v. AIG Property Casualty, Inc., 2021 

WL 1164091, at *1 (S.D.N.Y. Mar. 26, 2021) (criticizing the 

complaint at issue as “long on invective and indignation but 

short on facts”); MSP Recovery Claims, Series LLC v. New York 

Cent. Mut. Fire Ins. Co., 2019 WL 4222654, at *6 (N.D.N.Y. Sept. 

5, 2019) (“Plaintiffs’ tactics are a flagrant abuse of the legal 

system.”); MSP Recovery Claims, Series LLC v. USAA Gen. Indem. Co., 2018 WL 5112998, at *13 (S.D. Fla. Oct. 19, 2018) (“In 

light of the ever-shifting allegations Plaintiff has presented in 

its four versions of its pleading, it is evident Plaintiff has 

played fast and loose with facts, corporate entities, and adverse judicial rulings.”). 

Do not misread our opinion. Our message is directed to 

the plaintiffs and their counsel before us and, even more specifically, to the claims they continue to press in federal court. 

And our holding rests on a well-established principle of 

standing law—the lack of any injury in fact by virtue of the 

plaintiffs making no showing of a primary payer’s failure to 

pay a particular obligation under the Medicare Act. Other areas of law (under consumer protection statutes perhaps most 
18 No. 20-1268 

especially) continue to present difficult and unsettled questions of Article III standing in the wake of Spokeo. We do not 

intend our warnings in this case to chill good-faith litigation 

on those broader issues of standing. But these plaintiffs’ sue 

first and ask questions later approach risks stretching the limits of judicial patience, and counsel for the plaintiffs would be 

well advised to confirm the existence of an actual injury before once again availing themselves of the judicial process. 

With these observations in mind, we AFFIRM.