Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1641_3314.pdf
Page Number: 1.0

(Slip Opinion) 

OCTOBER  TERM,  2021 

1 

Syllabus 

NOTE:  Where  it  is  feasible,  a  syllabus  (headnote)  will  be  released,  as  is 
being  done  in  connection  with  this  case,  at  the  time  the  opinion  is  issued. 
The  syllabus  constitutes  no  part  of  the  opinion  of  the  Court  but  has  been 
prepared  by  the  Reporter  of  Decisions  for  the  convenience  of  the  reader. 
See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337. 

SUPREME COURT OF THE UNITED STATES 

Syllabus 

MARIETTA MEMORIAL HOSPITAL EMPLOYEE 
HEALTH BENEFIT PLAN ET AL. v. DAVITA INC. ET AL. 

CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR 
THE SIXTH CIRCUIT 

No. 20–1641.  Argued March 1, 2022—Decided June 21, 2022 

Petitioner Marietta Memorial Hospital Employee Health Benefit Plan is
an employer-sponsored group health plan that offers all of its partici-
pants the same limited coverage for outpatient dialysis.  Respondent
DaVita—a  major  provider  of  dialysis  services—sued  the  Marietta 
Plan, arguing that the Plan’s limited coverage for outpatient dialysis 
violated  the  Medicare  Secondary  Payer  statute.    The  statute  makes 
Medicare  a  “secondary”  payer  to  an  individual’s  existing  insurance 
plan  for  certain  medical  services,  including  dialysis,  when  that  plan
already covers the same services.  42 U. S. C. §§1395y(b)(1)(C), (2), (4). 
To  prevent  plans  from  circumventing  their  primary-payer  obligation
for  end-stage  renal  disease  treatment,  the  statute  imposes  two  con-
straints relevant here.  First, a plan “may not differentiate in the ben-
efits  it  provides  between  individuals  having  end  stage  renal  disease 
and other individuals covered by such plan on the basis of the existence
of end stage renal disease, the need for renal dialysis, or in any other 
manner.”   §1395y(b)(1)(C)(ii).   Second,  a  plan  “may  not  take  into  ac-
count that an individual is entitled to or eligible for” Medicare due to 
end-stage renal disease.  §1395y(b)(1)(C)(i); see §426–1.  The District 
Court dismissed DaVita’s claims that the Marietta Plan violated both 
statutory constraints.  A divided panel of the U. S. Court of Appeals 
for the Sixth Circuit reversed.  Among other things, the Court of Ap-
peals ruled that the statute authorized disparate-impact liability and 
that the limited payments for dialysis treatment had a disparate im-
pact on individuals with end-stage renal disease.   

Held: Section 1395y(b)(1)(C) does not authorize disparate-impact liabil-
ity, and the Marietta Plan’s coverage terms for outpatient dialysis do 
not violate §1395y(b)(1)(C) because those terms apply uniformly to all