Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1641_3314.pdf
Page Number: 5

Cite as:  596 U. S. ____ (2022) 

3 

Opinion of the Court 

The  Marietta  Memorial  Hospital  Employee  Health 
Benefit Plan is an employer-sponsored group health plan. 
The Plan offers the same terms of coverage for outpatient 
dialysis to all of its participants.  But under the Plan, out-
patient dialysis services are subject to relatively limited re-
imbursement rates. 

In  2018,  DaVita  sued  the  Plan,  arguing  that  the  Plan’s
limited coverage for outpatient dialysis both (i) differenti-
ates between individuals with and without end-stage renal
disease and (ii) takes into account the Medicare eligibility 
of  individuals  with  end-stage  renal  disease  in  violation of 
the Medicare Secondary Payer statute.  §1395y(b)(1)(C).

The District Court dismissed DaVita’s claims, concluding
that  the  Plan  does  not  violate  the  anti-differentiation  or 
take-into-account  provisions  of  the  Medicare  Secondary 
Payer statute because the Plan’s terms, including its terms 
for  outpatient  dialysis  treatments,  apply  uniformly  to  all
Plan participants. 

A divided panel of the U. S. Court of Appeals for the Sixth
Circuit reversed.  See 978 F. 3d 326 (2020).  Among other
things, the Court of Appeals ruled that the statute author-
ized  disparate-impact  liability,  and  the  Court  concluded
that the limited payments for dialysis treatment had a dis-
parate impact on individuals with end-stage renal disease. 
Judge Eric Murphy dissented in relevant part.  He rea-
soned that the Plan’s terms do not violate the statute be-
cause the Plan “offers the same benefits to all participants.” 
Id., at 358 (opinion concurring in judgment in part and dis-
senting in part).

The  Sixth  Circuit’s  interpretation  of  the  Medicare  Sec-
ondary Payer statute departed from the holdings of district
courts that had considered the question.  See DaVita, Inc. 
v. Amy’s Kitchen, Inc., 379 F. Supp. 3d 960 (ND Cal. 2019); 
Dialysis of Des Moines, LLC v. Smithfield Foods Healthcare 
Plan,  2019  WL  8892581  (ED  Va.,  Aug.  5,  2019);  National 
Renal Alliance, LLC v. Blue Cross & Blue Shield of Georgia,