Opinion ID: 613077
Heading Depth: 4
Heading Rank: 6

Heading: Summary of Holdings and Implications for This Case

Text: We pause briefly to review our holdings. The demonstrated responsibility provision in the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2)(B)(ii), does not apply to lawsuits brought by private parties under the Act's private cause of action, id. § 1395y(b)(3)(A), because the Act does not purport to create an action by healthcare providers against tortfeasors. Rather, that provision applies only to lawsuits brought by Medicare for reimbursement. Nor does that provision limit lawsuits against traditional insurers; it limits only lawsuits against tortfeasors. The proper scope of the demonstrated responsibility provision, therefore, is to limit the class of alleged tortfeasors whom Medicare can sue for reimbursement: those who have already been adjudged liable (or have entered into a settlement, etc.) for causing harm that led to Medicare expenses. Applying these holdings to our case, it is clear that Bio-Medical must prevail under the Act's private cause of action. The private cause of action entitles the plaintiff to double damages when the defendant failed to pay in accordance with paragraphs (1) and (2)(A). Id. Bio-Medical sued Central States under the private cause of action, and as discussed in Part III(A) above, Bio-Medical has proven that Central States failed to pay in accordance with paragraphs (1) and (2)(A). Accordingly, Central States is liable under the private cause of action. All that remains is to answer one more lingering puzzle: What is the proper amount of double damages?