In these two consolidated appeals we consider whether a plaintiff who has alleged no injury to himself has standing to bring suit under the Medicare Secondary Payer statute, 42 U.S.C. § 1395y(b)(3)(A). Because we conclude that the suit authorized by the statute is a private cause of action, which requires the plaintiff to have standing in his own right, rather than a qui tam statute, which allows the plaintiff to assert injury to the United States, we affirm the district courts’ 1 dismissal of these cases.
Both of these cases were filed by the same plaintiff, Douglas B. Stalley, who has also filed many similar cases around the country. 2 Stalley alleges that the defendants Catholic Health- Initiatives 3 and Triad Hospitals, Inc. 4 are medical care providers participating in the Medicare program, who partly self-insure for malpractice. He alleges that the insurance company defendants 5 were subsidiaries or *520 sister companies to the provider defendants and wrote malpractice insurance for the provider defendants.
Stalley’s substantive allegations are substantially the same in the two suits before us:
On numerous occasions, [the provider defendants] by and through [their] employees and agents, caused harm to Medicare recipients who were patients in [the defendants’] hospitals, thereby triggering legal obligation on the part of [the hospital defendants] and the other primary payer Defendants herein to pay for any consequential medical service, treatment, or medication. Nevertheless, [the provider defendants] provided medical services, treatment, and medication to such Medicare recipients who were harmed by [the provider defendants’] own conduct, and thereafter received reimbursement from Medicare for treating those injured Medicare recipients.
The complaints allege that the insurer defendants knew that the provider defendants had injured the Medicare beneficiaries and that the insurer defendants were liable as primary payers, yet the insurer defendants did not reimburse Medicare for the costs of treatment. The complaint does not allege that Stalley was either a Medicare beneficiary or a patient of the defendants or that he was injured by the defendants in any way. For that matter, the complaint does not identify any particular person who was injured by the defendants at any particular time.
The defendants in both cases moved to dismiss for lack of jurisdiction and for failure to state a claim. Both district courts granted the motion. The district court in the
Catholic Health Initiatives
case ruled first, holding that Stalley lacked constitutional standing to bring the suit because he had not alleged any injury to himself.
Stalley v. Catholic Health Initiatives,
The standard of review of a district court’s decision under Fed.R.Civ.P.
*521
12(b)(1) depends on whether the district court resolved a facial attack or a factual attack on subject matter jurisdiction.
Osborn v. United States,
The party invoking federal jurisdiction has the burden of establishing that he has standing to assert the claim.
Lujan v. Defenders of Wildlife,
Stalley does not contend that he himself has sustained any injury in fact. Instead, he contends that the Medicare Secondary Payer statute is a
qui
tam
7
statute. A
qui tam
statute effectively assigns part of the government’s interest to a relator so that the relator has standing to assert an injury suffered by the government.
See Vt. Agency of Nat. Res. v. United States ex rel. Stevens,
The plain language of § 1395y(b)(3)(A) says, “There is established a
private cause of action
for damages ...” (emphasis added). A “private” right is different from a public right,
see Black’s Law Dictionary,
“Right” (8th ed.2004) (private right is defined as “A personal right, as opposed to a right of the public or the state.”), and
qui tam
cases exist to vindicate public rights. Thus, the Medicare Secondary Payer statute purports to give a substantive right to individuals
qua
individuals, not as private attorneys general or assignees of a public right. In contrast, the False Claims Act
qui tam
provision authorizes a private person to bring a civil action “for the person and for the United States Government. The action shall be brought in the name of the Government.” 31 U.S.C. § 3730(b). Moreover, the Medicare Secondary Payer statute lacks any provisions giving the government the right to control the action, such as the right to dismiss the action, the right to veto a dismissal or settlement, and the right to review the complaint
in camera
before the relator serves the complaint on the defendant. Again, in contrast, the False Claims Act has extensive provisions giving the government these rights and more.
See
31 U.S.C. § 3730. The absence of procedural safeguards giving the executive branch control over the prosecution of the action and the proceeds is powerful evidence that Congress did not mean § 1395y(b)(3)(A) to function as a
qui tam
statute.
See United Seniors Ass’n,
Stalley relies on a statement in
Mason v. American Tobacco Co.,
Even though the private right of action under § 1395y(b)(3)(A) shares these characteristics of a
qui tam
statute, it may not be a
qui tam
statute if Congress intended the plaintiff to act as a private plaintiff, asserting his own injury, rather than as a relator, asserting the government’s injury. Despite language in some circuit-level decisions indicating that the private plaintiff can assert the government’s rights under § 1395y(b)(3)(A),
Glover v. Liggett Group, Inc.,
Stalley argues that the statute cannot be read to contemplate that only a private party who was actually injured can assert the private right of action. Stalley argues that such a reading is impossible because no private plaintiff would ever have an injury which would both (1) be a cognizable injury for which the plaintiff could recover and (2) lead to a recovery which the government could recoup. Thus, Stal-ley says that the only way the “private right of action” can help the government recoup money from primary payers is if it functions as a qui tam statute empowering a private person to assert the government’s rights, rather than his own rights. Therefore, according to Stalley, a volunteer like himself, who has no relationship with the primary payer and has suffered no injury, can sue under the private right of action and recover double damages for the injury to the government. Catholic Health Initiatives’ brief declines to identify a case in which the private right of action would be enforceable by an individual and lead to recoupment of Medicare expenses by the government; Catholic Health Initiatives tells us that we “need not even delve into this sort of speculation about the MSP statute’s possible uses,” but if there were truly no way that the private right of action would ever have any effect under Catholic Health Initiatives’ interpretation, that would be a powerful argument that such an interpretation was wrong. To understand whether Stalley’s argument is correct, we have to determine how the Medicare Secondary Payer statute as a whole was meant to work and how the private right of action fits within that framework.
Medicare is a federal program that provides health insurance for the elderly, the disabled, and renal patients.
Blue Cross & Blue Shield of Tex., Inc. v. Shalala,
Congress added a private right of action to the Medicare Secondary Payer statute in 1986. Pub.L. No. 99-509, § 9319, 100 Stat. 1874 (1986) (codified as amended at 42 U.S.C. § 1395y(b)(3)(A)). Section 1395y(b)(3)(A) grants the Medicare beneficiary a private right of action for double damages against an insurer or other primary payer that fails to pay the amounts it owes on the insured’s behalf. The parties do not point us to any legislative history explaining the purpose of the private right of action, nor have we found any legislative history directly explaining how the private right was meant to work.
See
H.R. Conf. Rpt. No. 99-1012, at 321 (1986),
reprinted in
1986 U.S.C.C.A.N. 3868, 3966 (merely stating that the private right of action is “to enforce the provision for the aged”); S. Rpt. No. 99-348, at 140 (1986) (stating that obligation of primary payers “would be enforceable by private action or by the Federal Government”). Courts considering the provision have generally agreed that the apparent purpose of the statute is to help the government recover conditional payments from insurers or other primary payers.
See, e.g., United Seniors,
The thinking behind the statute is apparently that (1) the beneficiary can be *525 expected to be more aware than the government of whether other entities may be responsible to pay his expenses; (2) without the double damages, the beneficiary might not be motivated to take arms against a recalcitrant insurer because Medicare may have already paid the expenses and the beneficiary would have nothing to gain by pursuing the primary payer; and (3) with the private right of action and the double damages, the beneficiary can pay back the government for its outlay and still have money left over to reward him for his efforts.
Stalley contends that the statute has to be a qui tam statute because under the payment procedures outlined by the statute, Medicare will pay the beneficiary’s expenses when the primary insurer fails to pay, and as a result, the Medicare beneficiary will not have been injured by the primary payer’s failure to pay and cannot recover anything in his own right. Stalley argues that if the Medicare beneficiary has not been injured, Congress must have intended the private right of action to allow the private plaintiff to sue on behalf of the government, the only injured party. Under Stalley’s reasoning, the private right of action is merely an assignment of the government’s public right.
We reject the assertion that a Medicare beneficiary could never have an injury of his or her own to vindicate by means of the private right of action. There are two scenarios in which a private plaintiff conceivably could bring suit under the Medicare Secondary Payer statute: either the insurer failed to pay and the government has not paid, or else the insurer failed to pay and the government did pay. In the first case, the plaintiff was obviously injured by the insurer’s failure to pay, but the government has not yet paid any money. This would not appear to be the factual situation which the statute was created to remedy, because in this case, the government would have nothing to recover and therefore would not benefit from the services of the informer/plaintiff. If the first situation were the only one in which the beneficiary could sue, the private right of action would not save the government money. Moreover, in this first factual situation, there would be no need for the double damages incentive; if the government had not paid the expenses, the beneficiary would have an incentive to sue the primary payer even without double damages, to avoid having to pay the expenses him or herself.
In the second case, in which the primary payer failed to pay and the government has paid the expense, has the Medicare beneficiary been injured by the primary payer’s failure to pay something the government paid anyway? Triad Hospitals and related defendants argue that a beneficiary whose primary payer refused to pay would have damages even if Medicare paid the beneficiary’s expenses because the beneficiary would have to pay Medicare co-payments and deductibles. But as Stal-ley points out, if those were the beneficiary’s only damages, the beneficiary could only recover those amounts, not the amount that Medicare paid on its behalf. The co-payments and the deductible would be costs that are not covered by Medicare, so Medicare would not be entitled to recover those costs from the beneficiary. Thus, Stalley argues, if the Medicare beneficiary can only recover expenses not paid by Medicare, the private right of action would not help the government recoup anything and it would be completely ineffectual as an aid to Medicare’s recovery efforts; this compels the conclusion, he says, that the private plaintiff must be able to assert the government’s rights directly, because there is no way the plaintiffs assertion of its own rights would help the government collect any money.
*526
We conclude that Stalley’s reasoning is flawed. Congress must have intended that a Medicare beneficiary could sue its primary insurer for expenses Medicare had already paid. There was authority extant in several states when Congress enacted the private right of action in 1986 that a Medicare beneficiary could sue his private insurer and recover his expenses incurred, even if those expenses had already been paid by Medicare.
See Holmes v. Cal. State Auto. Ass’n,
On the other hand, the Third Circuit in
Wheeler v. Travelers Ins. Co.,
*527 Our study of the Medicare Secondary Payer statute convinces us that Congress contemplated that Medicare beneficiaries could recover double damages to vindicate their private rights when their primary payers fail to live up to their obligations, even if Medicare has made a conditional payment of the beneficiaries’ expenses. Therefore, there is no need to read the statute as permitting a plaintiff to assert the public’s rights in contravention of the plain language creating a private right of action. Accordingly, we reject Stalley’s argument that Congress created the private right of action to permit private persons to assert the government’s rights, rather than their own, for we conclude that Congress rationally could have intended § 1895y(b)(3)(A) to provide Medicare beneficiaries a cause of action against their defaulting primary payers, with the anticipation that a portion of the beneficiary’s recovery would be paid to reimburse Medicare.
With the demise of his principal argument, Stalley’s case quickly crumbles. Stalley relies on the regulations that require a beneficiary whose expenses have been paid by Medicare and who then receives a payment from a primary payer to reimburse Medicare. 42 C.F.R. § § 411.20 & 411.37. He contends that these regulations indicate the statute is a qui tam statute since they show that the proceeds will be split between the plaintiff and the government. Far from showing that the proceeds result from the plaintiff asserting the government’s rights, the regulations are consistent with the idea that the Medicare beneficiary asserts his or her rights against the primary payer and the government then asserts its own rights against the beneficiary, see § 1395y(b)(2)(B)(iii).
In sum, the private right of action provided by 42 U.S.C. § 1395y(b)(3)(A) is not a qui tam statute, and Stalley, who is a volunteer and who lacks any injury in fact, does not have standing to pursue such an action.
Stalley contends that the district court should have allowed him to replead, but in view of the fact that he has not indicated any amendment he could make that would cure the defect in his complaint, the district court correctly denied permission to replead as futile.
Stalley’s motion to strike the Appellees’ appendices in No. 06-4121 is denied.
We affirm the district courts’ dismissal of the complaints.
Notes
. The district judge in Stalley v. Catholic Health Initiatives, No. 06-3884, was the late Honorable George Howard, Jr., United States District Judge for the Eastern District of Arkansas. The district judge in Stalley v. Triad Hospitals, No. 06-4121, was the Honorable William R. Wilson, United States District Judge for the Eastern District of Arkansas.
. Erin Brockovich has filed a number of similar cases in California.
. Stalley also lists Bergen Mercy Foundation, Inc., Alegent Health-Bergen Mercy Health System, Alegent Health as provider plaintiffs, but refers to these together with Catholic Health Initiatives as “CHI.”
. Stalley also lists Triad Hospitals LLC and Triad Hospital Holdings, Inc. as provider plaintiffs, but refers to thése defendants together with Triad Hospitals, Inc. as "Triad.”
. In the Catholic Health Initiatives case, the insurer defendants are Preferred Professional Insurance Company and Advocate Insurance Resources, SPC. In the Triad case, the insurer defendants are Parthenon Insurance Company, Limited, Health Midwest Insurance Company, Limited, and Health Care Indemnity, Inc.
. An incomplete list of other district court cases dismissing Stalley's or Brockovich’s § 1395y(b)(3)(A) claims for lack of standing includes
Stalley v. Orlando Regional Healthcare Systems, Inc.,
No. 06-1824,
.
"Qui tam
is short for the Latin phrase
qui tam pro domino rege quam pro se ipso in hoc parte sequitur,
which means 'who pursues this action on our Lord the King’s behalf as well as his own.’ ”
Vt. Agency of Nat. Res. v. United States ex rel. Stevens,
