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9th Circuit Holds that CARES Act does not provide a private right of action to enforce violations of § 3202

On September 9, 2023, the 9th Circuit held that the CARES Act doesn't create a private right of action for providers to sue payors for COVID-19 reimbursement disputes. In the lawsuit, an out of network provider brought 5 causes of action against Aetna seeking the difference between what Aetna reimbursed the provider for its COVID-19 tests and the provider's posted cash price. 

"The use of mandatory language requiring reimbursement at the cash price does not demonstrate Congress’s intent to create such a right. " Saloojas, Inc. v. Aetna Health of California, Inc., Docket No. 22-16034 (9th Cir. Jul 18, 2022), Court Docket

The case was an appeal of a motion to dismiss filed by Aetna. The 9th Circuit reviewed the statute to determine if Congress intended to create a private right and a private remedy, noting that the "central inquiry remains whether Congress intended to create, either expressly or by implication, a private cause of action." Id. The 9th Circuit found that because the language of the statute focused on the regulated party (in this case the payors) and that the providers were simply the object of the regulatory party's obligation that the CARES Act didn't have language sufficient to create a private right of action for providers to sue payors. The 9th Circuit noted that it was the first circuit to rule on this issue but that all the district courts faced with the issue concluded that no private right of action exists under the CARES Act.


healthcare, enforcement, covid-19, cares act