RAMP Act Introduced in the Senate - Proposes to Modify Double Damages

February 18, 2026 / 4 min read

In a new Medicare secondary payer (MSP) development, on February 10, 2026, the Repair Abuses of MSP Payments (RAMP) Act was introduced into the U.S. Senate as S. 3816 by Tim Scott (R-SC) and Maggie Hassan (D-NH). As many may recall, the RAMP Act was introduced in the U.S. House of Representatives in June 2025 as H.R. 4056 by Rep. Gus Bilirakis (R-FL) and Rep. Brad Schneider (D-IL). By way of brief history, the RAMP Act was first introduced into the House in 2022 as part of the 117th Congress.^[1] In 2023, the proposed legislation was reintroduced into the House and Senate as part of the 118^th Congress.^[2] These prior bills expired without being enacted into law as part of the above referenced Congressional sessions.

2nd RAMP Act GettyImages-1015264434

RAMP Act proposals

The RAMP Act (S. 3816/H.R.4056) proposes to modify the Medicare Secondary Payer (MSP) Act’s private cause of action (PCA) statute, codified at 42 U.S.C. § 1395y(b)(3)(A), by limiting its scope to group health plans.

Currently, the MSP’s PCA provision reads as follows:

(3) Enforcement (A) Private cause of action - There is established a private cause of action for damages (which shall be in an amount double the amount otherwise provided) in the case of a primary plan which fails to provide for primary payment (or appropriate reimbursement) in accordance with paragraphs (1) and (2)(A).

The RAMP Act proposes to modify the above private cause of action statute as follows:

SEC. 2. PRIVATE CAUSE OF ACTION FOR DAMAGES IN THE CASE OF A GROUP HEALTH PLAN WHICH FAILS TO PROVIDE FOR PRIMARY PAYMENT OR APPROPRIATE REIMBURSEMENT. Section 1862(b)(3)(A) of the Social Security Act (42 U.S.C. 1395y(b)(3)(A)) is amended by striking ``primary plan'' and inserting ``group health plan (as defined in paragraph (1)(A)(v)).”^[3]

The RAMP Act effort is being led, in main part, by the Medicare Advocacy Recovery (MARC) coalition which, as many will recall, is the same group that was instrumental in securing passage of the Strengthening Medicare and Repaying Taxpayers Act (SMART Act) (P.L. No: 112-242) back in 2012 and, more recently, the Provide Accurate Information Directly Act (PAID Act) (P.L. No. 116-215) in 2021.

In support of the RAMP Act, MARC argues that the private cause of action is no longer necessary. Specifically, a coalition press release pertaining to the RAMP Act’s introduction into the House last summer states: “MARC advocates for the RAMP Act because the private cause of action is no longer necessary, due to changes in the MSP laws over time. Thanks to these changes, the private cause of action prevents beneficiaries from resolving claims and can make Medicare the primary payer in cases it should not be the primary payer.”^[4]Similarly, the coalition’s press release regarding its Senate introduction notes that “[t]he legislation advocates for an update to the Medicare Secondary Payer (MSP) system by modernizing the outdated MSP ‘private cause of action’ provision.”^[5]

Claims Considerations

From a practical claims perspective, one area where the RAMP Act may be of particular interest to many NGHP insurers relates to its potential impact regarding Medicare Advantage Plans (MAPs) recovery claims. Specifically, as many are aware, over the past decade certain MAPs, or assignees of these plans, have brought several lawsuits against NGHPs seeking “double damages” under this provision.^[6] Repeal of the current private cause of action provision as it relates to non-group health plans would appear to eliminate these types of lawsuits against NGHP insurers going forward.

Outside of the MAP recovery context, the RAMP Act will likely interest others given the several other questions and litigation the private cause of action provision has generated on other fronts. While a complete examination into these issues is beyond the scope of this article, from the author’s research, two questions that have resulted in litigation over the years have included who may sue under this provision^[7] and exactly “when” double damages liability may attach.^[8]

Going forward, with the RAMP Act now introduced in both chambers, it will be interesting to see where this proposed legislation heads next in Congress which will help us assess the bill’s potential prospects for passage in the current legislative session which ends on January 3, 2027. The Verisk policy team will closely monitor the bill’s progress and will provide updates as warranted.

[1] The RAMP Act was introduced into the House as H.R.8063 as part of the 117^th Congress.

[2] The RAMP Act was introduced in the House as H.R. 3388 and in the Senate as S. 1607 as part of the 118^th Congress.

[3] H.R. 4056 and S. 3816, Repair Abuses of MSP Payments Act, Sec. 2 (119^th Congress).

[4] (2025, June 20), MARC Announces Introduction of the RAMP Act in 119th Congress. MARC Coalition. https://marccoalition.com/2025/06/20/marc-announces-introduction-of-the-ramp-act-in-119th-congress/.

[5] (2026, February 10), RAMP Act Introduced in United States Senate. MARC Coalition. https://marccoalition.com/2026/02/10/ramp-act-introduced-in-united-state-senate/

[6] On this point, there has been considerable litigation regarding whether MAPs may bring actions under the current PCA statute. To date, the United States Circuit Courts of Appeals for the Second, Third, and Eleventh Circuits, in Aetna Life Insurance Company v. Big Y Foods, Inc., 52 F.4th 66 (2^nd Cir. October 26, 2022), In re Avandia, 685 F.3d 353 (3rd Cir. 2012), and Humana v. Western Heritage Insurance Co., 832 F.3d 1229 (11th Cir. 2016), respectively, have ruled that the MSP’s PCA statute applies to MAPs allowing them to use this provision to sue insurers for double damages. In addition, several United States District courts have ruled that MAPs can sue for “double damages” under the current PCA, including: California: MAO-MSO Recovery II, LLC v. Mercury Insurance, 2018 WL 3357493 (C.D. Calif. 2018); MAO-MSO Recovery II, LLC v. Farmers Insurance Exchange, 2018 WL 2106467 (C.D. Calif. 2018); Connecticut: Aetna v. Guerrera, 300 F.Supp.3d 367 (D. Conn 2018); Illinois: MAO-MSO Recovery II, LLC v. State Farm, 2018 WL 340021 (C.D. Ill. 2018); MSP Recovery Claims, Series 44 v. Zurich, 2023 WL 5227396 (N.D. Illinois 2023); Louisiana: Collins v. Wellcare Healthcare Plans, Inc., 73 F.Supp.3d 653 (E.D. La. 2014); Maryland: MAO-MSP Recovery II, LLC v. Government Employers Ins. Co., 2024 WL 2924063 (D. Maryland 2024); Massachusetts: MSP Recovery Claims Series LLC v. Plymouth Rock Assurance Corporation, 404 F.Supp.3d 470 (D. Massachusetts 2019) and MSP Recovery Claims v. Massachusetts Insurance Company, et. al., 2025 WL 2373997 (D. Mass, August 14, 2025); Ohio: MSP Recovery Claims, Series LLC v. Phoenix Insurance Company, 426 F.Supp. 3d 458 (N.D. Ohio, 2019); MSP Recovery Claims, Series LLC v. Grange Insurance Company, 2019 WL 6770729 (N.D. Ohio 2019); and MSP Recovery Claims, Series LLC v. Progressive Corporation, 2019 WL 5448356 (N.D. Ohio 2019); South Carolina: Humana Ins. Co. v. Bi-Lo, LLC, 2019 WL 4643582 (D. South Carolina 2019); Tennessee: Cariten Health Plan, Inc. v. Mid-Century Ins. Co., No.: 2015 WL 5449221(E.D. Tenn. 2015); Texas: Humana Ins. Co. v. Farmers Tex. Cnty. Mut. Ins. Co., 95 F.Supp.3d 983 (W.D. Tex. 2014) and Humana v. Shrader, 584 B.R. 658 (S.D. Tex. 2018); and Virginia: Humana Ins. Co. v. Paris Blank LLP, 187 F. Supp.3d 676 (E.D. Va. 2016).

[7] As noted, one issue that has resulted in considerable litigation over the years is exactly “who” can sue under the PCA statute given that the text of the PCA is silent on this point. While the federal government is granted the express right to bring a claim under the PCA through another MSP provision (42 U.S.C. § 1395y(b)(2)(B)(iii)) the PCA statute itself provides no indication as to who may bring suit under its provisions. While a complete review of the full collection of cases addressing this question is beyond the scope of this article, it is noted that several courts have ruled that the PCA provision is not a qui tam statute. A qui tam action has been described as an action where “a private plaintiff, known as a “relator,” brings suit on behalf of the government to recover a remedy for a harm done to the government.” See, Wood v. Empire Health Choice, Inc., 574 F.3d 92, 97 (2d Cir. 2009). In this regard, as one court commented, “[n]ot just anyone can wander in off the street and avail themselves of the MSP Act’s private cause of action.” Netro v. Greater Baltimore Medical Center, Inc., 891 F.3d 522, 528 (4^th Cir. June 4, 2018). Rather, as another court explained, “the PCA statute merely enables a private party to bring an action to recover from a private insurer only where that private party has itself suffered an injury because a primary plan has failed to make a required payment to or on behalf of it” (authors’ emphasis). Woods v. Empire Health Choice, Inc., 574 F.3d 92, 101 (2d Cir. 2009). See also., In re Avandia Marketing, Sales Practices & Products Liability Litig., 685 F.3d 353 (3d Cir. 2012); ; Stalley ex rel. United States v. Orlando Regional Healthcare Sys., Inc., 524 F.3d 1229 (11th Cir. 2008); Stalley v. Methodist Healthcare, 517 F.3d 911 (6th Cir. 2008); Stalley v. Catholic Health Initiatives, 509 F.3d 517 (8th Cir. 2007); United Seniors Ass'n v. Philip Morris USA, 500 F.3d 19 (1st Cir. 2007); Netro v. Greater Baltimore Medical Center, Inc., 891 F.3d 522 (4^th Cir. 2018); and O’Connor v. Mayor and City of Baltimore, 494 F.Supp.2d 372 (D. Maryland, July 19, 2007). Similarly, another court found that “the private right of action provided by 42 U.S.C. § 1395y(b)(3)(A) is not a qui tam statute, and [a plaintiff], who is a volunteer and who lacks any injury in fact, does not have standing to pursue such an action” and, thus, the MSP “allows a private plaintiff to assert his own rights, not those of the government.” Stalley v. Catholic Health Initiatives, 509 F.3d 517, 527 (8^th Cir. 2007). In terms of which parties the PCA statute does apply, it is noted that, in general, courts have found that Medicare beneficiaries can sue under the PCA, See e.g., Estate of McDonald v. Indemnity Insurance, 46 F.Supp.3d 712 (W.D. Ky. 2014) and O’Connor v. Mayor and City of Baltimore, 494 F. Supp. 2d 372 (D. Maryland, July 19, 2007), as well as medical providers, see e.g., Michigan Spine and Brain Surgeons, PLLC v. State Farm Mut. Auto. Ins. Co., 758 F.3d 787 (6^th Cir. 2013).

[8] As mentioned, another question involving the private cause of action statute concerns “when” double damages should apply. In this regard, the author has selected the following cases which highlight the types of issues that have arisen:

In Estate of McDonald v. Indemnity Insurance, 46 F.Supp.3d 712 (W.D. Ky. 2014), the court had to address whether the defendant’s alleged delay in reimbursing Medicare warranted imposition of double damages. Very generally, in this case, the workers’ compensation insurer, via court order, was required to reimburse the claimant for medical expenses incurred (including Medicare payments related thereto). Two years after this order was issued, the Estate filed a PCA action alleging that the insurer had still not reimbursed Medicare. Shortly after suit was filed, the insurer paid Medicare. The court, proceeding from the factual assumption that the insurer did nothing in the two years from the court order to reimburse Medicare, levied “double damages” against the insurer. However, the court eventually amended this portion of its order after the insurer subsequently produced evidence showing engagement with Medicare on the matter following the court’s order and before the Estate filed its PCA action. Considering this new evidence, the court referred the case for further proceedings stating that “[u]pon review, it appears that [the insurer’s] offer of evidence suggests that this court’s impression that [the insurer] had done nothing to appropriately reimburse Medicare until prompted to do so by this suit may have been misinformed. As such, a failure to permit the issue to be fully developed may result in a miscarriage of justice. The parties will be permitted to develop the underlying facts and present fulsome argument on the question of appropriate reimbursement and the Estate’s entitled to a damage award, if any.” See, Estate of McDonald v. Indemnity Insurance, 107 F.Supp.3d 764, 768 (W.D. Ky. 2015).

This issue also surfaced in Netro v. Greater Baltimore Medical Center, Inc., 891 F.3d 522 (4^th Cir. 2018). In this case, the United States Circuit Cout of Appeals for the Fourth Circuit, in addition to finding that the personal representative had standing to sue under the PCA statute, also had to address whether double damages were warranted given the defendant’s alleged delayed payment. Very generally, in a state court trial, a Maryland jury found the defendant liable and awarded $451,956.00 in damages on July 22, 2016. This amount included $157,730.75 for Medicare conditional payments, which Netro (the personal representative of the plaintiff’s estate) was obligated to use to reimburse Medicare. The defendant asked the court to reduce the judgment post-verdict to more accurately reflect medical expenses actually paid. On October 31, 2016, the court issued a revised final order reducing the judgment amount. Three weeks later, Netro filed her PCA action in federal court alleging the defendant’s failure to pay the judgment (by that point in time) made it liable for double damages. The defendant ultimately paid the judgment on December 7, 2016 (37 days after the court’s revised judgment).

Netro argued, in part, that defendant’s delayed payment warranted double damages. However, the court rejected Netro’s argument and found that the facts did not support double damages in this case stating as follows:

Netro received the funds owed to Medicare 37 days after the revised final state court judgment. That delay hardly constitutes a ‘fail[ure]’ to pay under the MSP Act … There cannot be a failure to pay when there has been payment. Netro would have us transform the statute to read ‘unreasonable delay.’ But this we cannot do. While there might at some point be a delay of such length that it would amount to a failure, that is not at all this case. Netro v. Greater Baltimore, 891 F.3d 522, 528-529 (4^th Cir. 2018).

Likewise, the court rejected Netro’s position that the defendant’s potential liability should be measured from the original July order noting that “even if we were to start the clock in July, it is not apparent that [the defendant] violated the MSP Act. Again, [the defendant] ultimately paid Netro, who was then obligated to pay Medicare. And much of the delay she complains about was due to the state court’s consideration of the appropriate judgment amount, not any evasion by [the defendant].” Netro v. Greater Baltimore, 891 F.3d 522, 529 (4^th Cir. 2018).

Finally, the court rejected Netro’s contention that PCA damages should attach 60 days after a primary plan becomes responsible for reimbursing Medicare stating that “[the statutory text does not support any specific deadline, nor does Netro’s attenuated rationale—relying on a different statutory provision that authorizes Medicare to charge interest on conditional payments after 60 days.” Netro v. Greater Baltimore, 891 F.3d 522, 529 (4^th Cir. 2018). Further, the court observed that even if it adopted Netro’s proposed 60-day rule, the defendant actually made payment within 60 days from the October final order, which was the operative judgment date under Maryland law. Id.

More recently, the PCA issue arose again in Bronson Healthcare Group v. Conifer Insurance, 2026 WL 271561 (Mich. Ct. App. February 2, 2026). Very generally, in this case, a healthcare provider, Bronson Healthcare Group (Bronson), brought a PCA double damages claim against a workers’ compensation (WC) insurer in a denied WC case. While the WC proceedings were pending, Bronson filed a PCA claim against the insurer in trial court for the insurer’s alleged responsibility to repay Medicare’s covered expenses related to the WC case. The trial court ruled, in part, that in the event Bronson established Conifer’s obligation to pay for the claimant’s medical expenses, then Bronson would be entitled to “double damages.”

Meanwhile, in a separate proceeding, the workers’ compensation magistrate eventually issued an opinion finding the claimant was an employee and ruled that Conifer was responsible for covering her medical expenses and for repaying Medicare. Given this ruling, Bronson argued that the WC magistrate’s ruling resolved that the claimant was an employee thereby making Conifer responsible and, accordingly, that Conifer violated the MSP statute by failing to pay for the claimant’s medical expenses (thereby entitling to Bronson to double damages). The insurer rejected this and continued to argue that the claimant was not an employee, and, thus, not entitled to workers’ compensation benefits. While the insurer recognized the WC magistrate’s ruling to the contrary, the insurer argued that it was unaware of any caselaw making the WC ruling binding on the trial court and, thus, requested a stay pending their administrative appeal. The trial court denied the insurer’s request for a stay and granted, in part, Bronson’s summary disposition. Both parties then appealed to the Michigan Court of Appeals.

On appeal, the insurer argued that the trial court erred in finding them liable for PCA damages because when Bronson filed its suit it had not yet been demonstrated that the insurer was responsible. In this regard, Conifer argued that there was at a minimum a good faith question regarding whether the claimant was an employee at the time of the accident. Given this, the insurer argued that any requirement that it cover the claimant’s bills would not have arisen until and unless a court or administrative agency determined that the claimant was an employee. Of note, at the time of oral argument before the Michigan Court of Appeals, no decision had been rendered by the WC appeals board on the insurer’s appeal of the WC magistrate ruling.

The Michigan Court of Appeals framed the issue as: “When a workmen’s compensation insurer does not pay a medical provider for services rendered because there is a dispute over coverage, and Medicare makes a conditional payment under the Medicare Secondary Payer Act (MSPA) … does the provider have a private cause of action for double damages under the MSPA?” Bronson Healthcare Group, 2026 WL 271561, at *1. On this question, the Michigan Court of Appeals ruled that “as long as the insurer has a good-faith ground for disputing coverage, the service provider does not have a viable cause of action unless and until it is demonstrated that the insurer has a responsibility to pay but fails to do so in a timely manner consistent with the MSPA.” Bronson Healthcare Group, 2026 WL 271561, at *1.

Accordingly, the Michigan Court of Appeals vacated the trial court’s order and remanded the case back to the trial court for dismissal (without prejudice). As part of its analysis, the court embarked on a very detailed review of relevant MSP law in a compare/contrast mode which is outside the scope of this article. At the end of the day, the Court of Appeals agreed with a line of cases finding that the “demonstrated responsibility” provision contained in the MSP statute is a condition precedent to a PCA action under the MSP.

On this point, the Court of Appeals noted the following, which really gets at the crux of its rationale: “[a]lthough an initial decision in the workmen’s compensation proceedings has now arguably demonstrated Conifer’s responsibility for Roach’s medical care, Bronson Healthcare has not demonstrated that Conifer failed to reimburse Medicare within the meaning of the MSPA, and the trial court erred by granting summary disposition in favor of the medical provider. Because Bronson Healthcare filed this litigation prematurely, Conifer had no real opportunity to reimburse Medicare. At the very least, Conifer should be given that opportunity, as other workmen’s compensation insurers have been.” (citations omitted), Bronson Healthcare Group, 2026 WL 271561, at *9.

However, the court warned that its decision should not be “read to give carte blanche to a workmen’s compensation insurer or other primary payer to deny payment when the law or the plan’s own terms and conditions plainly provide coverage” noting that “… we reiterate today, a denial of coverage made in bad faith will not shield a primary payer from a double-damages lawsuit under the MSPA.” Bronson Healthcare Group, 2026 WL 271561, at *9.

The RAMP Act is Introduced in the Senate – Bill Proposes to Modify the MSP’s “Double Damages” Provision

RAMP Act proposals

Claims Considerations