Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita
The Facts
DaVita, a dialysis provider, alleged that Marietta Memorial's health plan violated the MSP Act by covering only three months of outpatient dialysis per year -- a limit that applied equally to all enrollees but disproportionately affected ESRD patients who rely on dialysis long-term. The Sixth Circuit found the plan discriminatory.
The Application
Marietta Memorial's uniform three-month dialysis cap applied the same terms to all enrollees regardless of ESRD status, satisfying the MSP Act's prohibition on differentiating benefits based on ESRD. Although the limit disproportionately burdened ESRD patients who require long-term dialysis, the Court held that disparate impact without disparate treatment does not constitute prohibited discrimination under the statute. The majority thus rejected DaVita's argument that facially neutral limits that happen to disadvantage ESRD patients violate the MSP Act's anti-discrimination provision.
The Conclusion
**Court ruled 7-2 for Marietta Memorial.** Kavanaugh wrote the majority. DaVita's MSP Act discrimination claim failed; the plan's uniform dialysis cap was lawful.
No circuit court data for this case.
Case Analysis
Overview
The Supreme Court held 7-2 that Marietta Memorial's employee health benefit plan did not discriminate against individuals with end-stage renal disease in violation of the Medicare Secondary Payer Act's anti-discrimination provision, even though the plan categorically limited dialysis benefits in a way that disadvantaged ESRD patients.
Facts
DaVita, a dialysis provider, alleged that Marietta Memorial's health plan violated the MSP Act by covering only three months of outpatient dialysis per year -- a limit that applied equally to all enrollees but disproportionately affected ESRD patients who rely on dialysis long-term. The Sixth Circuit found the plan discriminatory.
Issue
Whether an employer health benefit plan that applies uniform, non-patient-specific limits on dialysis coverage violates the Medicare Secondary Payer Act's prohibition on differentiating its benefits based on end-stage renal disease.
Rule
The MSP Act prohibits plans from differentiating their benefits based on ESRD status; a plan that applies the same terms to all enrollees regardless of diagnosis does not violate this prohibition even if ESRD patients are disproportionately affected.
Analysis
Marietta Memorial's uniform three-month dialysis cap applied the same terms to all enrollees regardless of ESRD status, satisfying the MSP Act's prohibition on differentiating benefits based on ESRD. Although the limit disproportionately burdened ESRD patients who require long-term dialysis, the Court held that disparate impact without disparate treatment does not constitute prohibited discrimination under the statute. The majority thus rejected DaVita's argument that facially neutral limits that happen to disadvantage ESRD patients violate the MSP Act's anti-discrimination provision.
Conclusion
**Court ruled 7-2 for Marietta Memorial.** Kavanaugh wrote the majority. DaVita's MSP Act discrimination claim failed; the plan's uniform dialysis cap was lawful.
Notes
OT2021. Added via SCOTUS bulk import 2026-05-14
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