In a 7-to-2 decision by conservative Judge Brett Kavanaugh, the Court ruled that the Marietta Memorial Hospital employee health plan did not violate federal law by limiting benefits for outpatient dialysis because it did. regardless of whether or not the patients suffered from end-stage renal disease. A lower court had ruled in favor of DaVita, lower Denver.
DaVita, which provides kidney dialysis services through a network of outpatient clinics, filed a lawsuit in 2018, arguing that the hospital’s plan violated Medicare’s secondary payer status, under which Medicare , the government healthcare program for people aged 65 and over, pays only after the patient’s existing insurance plan.
Given the high costs of care for end-stage kidney disease, the law prohibits health plans from differentiating between the benefits they provide to people with the disease and those who do not.
Kavanaugh wrote that while Congress could require health plans to provide particular benefits, Medicare’s secondary payer law does not dictate a particular level of dialysis coverage by a health plan.
“Neither the law nor DaVita provides a basis for determining when ambulatory dialysis coverage might be considered inadequate,” Kavanaugh wrote.
Following the decision, shares of DaVita, one of the country’s two largest dialysis providers, fell 10.5% by midday. Shares of German rival Fresenius Medical Care fell 9%.
DaVita’s attorneys had said a judgment against the company could open the door for other private health plans adopting terms to limit coverage for expensive dialysis treatments, forcing end-stage kidney disease patients to turn to Medicare .
End-stage renal disease is a condition in which a person’s kidneys stop working. It can be treated with a kidney transplant or dialysis.
“Alongside the kidney care community, we are deeply owed by today’s Supreme Court decision to overturn an important protection for Americans with chronic kidney disease,” said Javier Rodriguez, CEO of DaVita. , in a statement.
John Kulewicz, an attorney for the Marietta plan, thanked the court “for carefully reading the Medicare Secondary Payer Act.”
Judge Elena Kagan, in a dissenting opinion joined by her liberal colleague Sonia Sotomayor, said the ruling would create a “massive and inexplicable circumvention” of a ban aimed at preventing health plans from “passing on” the cost of Medicare dialysis.
“Now Congress will have to fix a law that this Court broke,” Kagan wrote.