Plaintiff-Appellant MSP Recovery Claims, Series LLC, appeals from a judgment of the United States District Court for the Southern District of New York (Ramos, J.) dismissing for lack of standing its putative class action against Defendant-Appellee Hereford Insurance Company and denying leave to amend. MSP Recovery Claims, Series LLC v. Hereford Ins. Co., No. 20-cv-4776, 2022 WL 118387 (S.D.N.Y. Jan. 11, 2022). On de novo review, we conclude that MSP lacks standing because its allegations do not support an inference that it has suffered a cognizable injury or that the injury it claims is traceable to Hereford. We also conclude that the district court did not abuse its discretion when it denied MSP leave to amend based on MSP’s repeated failures to cure. Accordingly, we affirm the judgment of the district court. AFFIRMED. SUSAN CARNEY, C.J. This appeal stems from one of numerous lawsuits that MSP Recovery Claims, Series LLC (“MSP”), has brought around the country seeking to recover from insurance companies that allegedly owe payments to Medicare Advantage Organizations (“MAOs”) under the Medicare Secondary Payer Act (the “MSP Act”). In the putative class action brought here, MSP charges Hereford Insurance Company (“Hereford”) with “deliberate and systematic avoidance” of Hereford’s reimbursement obligations under the MSP Act. Jt. App’x 33 (Am. Compl. 7). The district court dismissed MSP’s amended complaint for lack of standing and denied further leave to amend. MSP Recovery Claims, Series LLC v. Hereford Ins. Co., No. 20-cv-4776, 2022 WL 118387 (S.D.N.Y. Jan. 11, 2022). MSP now challenges that ruling. On de novo review, we conclude that MSP does not have standing under Article III because it has failed to establish either injury-in-fact or causation. We also conclude that the district court did not abuse its discretion in denying MSP leave to amend based on its repeated failures to cure. Accordingly, we AFFIRM the judgment of the district court. BACKGROUND I. Statutory Background A. The Medicare Secondary Payer Act Medicare is a government health insurance program that provides coverage for individuals who are 65 or older and for those who have certain disabilities. In 1965, when Medicare was first launched, it “acted as the first payer for many medical services, regardless of whether a Medicare beneficiary was also covered under another insurance plan.” Marietta Mem’l Hosp. Emp. Health Benefit Plan v. DaVita Inc., 142 S. Ct. 1968, 1971 (2022). In 1980, however, in part because of the program’s rising costs, Congress enacted the MSP Act, restructuring Medicare’s relationship with private insurers of Medicare beneficiaries. See Medicare and Medicaid Amendments of 1980, §953, 94 Stat. 2647 (codified as amended at 42 U.S.C. §1395y). In the MSP Act’s current iteration, Medicare is a “secondary payer” for certain medical services in relation to a beneficiary’s private insurance plan, which the MSP Act refers to as the “primary plan.”1 See 42 U.S.C. §1395y(b)(2)(A); see also Medicare and Medicaid Amendments of 1981, §2146, 95 Stat. 800. The primary plan typically has a duty to pay first on covered claims. In this way, the MSP Act transformed Medicare into “a back-up insurance plan to cover that which is not paid for by a primary insurance plan.” Aetna Life Ins. Co. v. Big Y Foods, Inc., 52 F.4th 66, 69 (2d Cir. 2022) (internal quotation marks omitted). The MSP Act thus provides that Medicare may not pay, in the first instance, for medical services received by a Medicare beneficiary when “payment has been made or can reasonably be expected to be made” by a “primary plan.” 42 U.S.C. §1395y(b)(2)(A). For these purposes, the term “primary plan” means a group or large group health plan, a workers’ compensation law or plan, an automobile or liability insurance policy or plan, or no-fault insurance. See id. When a primary plan “has not made or cannot reasonably be expected to make payment” for a particular service “promptly,” however, Medicare may make a conditional payment for the medical service in anticipation of being reimbursed by the primary plan. Id. §1395y(b)(2)(B)(i) (“Authority to make conditional payment”).2 Medicare is permitted to pay first in these limited circumstances so that beneficiaries need not pay for their medical services out-of-pocket and depend on reimbursement by the primary plan. The MSP Act makes Medicare’s payment “conditional,” however, because the primary plan may ultimately be responsible for the payment. When Medicare has made such a conditional payment and “it is [later] demonstrated that [a] primary plan has or had a responsibility to make payment with respect to such item or service,” the primary plan — or the individual or entity that has already received payment from the primary plan — must reimburse Medicare. Id. §1395y(b)(2)(B)(ii) (“Repayment required”).3 Finally, the MSP Act establishes a private cause of action for double damages “in the case of a primary plan which fails to provide for primary payment (or appropriate reimbursement)” in accordance with the statute. Id. §1395y(b)(3)(A). B. The Medicare Advantage Program The Medicare Advantage (“MA”) Program, established in 1997 by the addition of Part C of Medicare, permits Medicare beneficiaries to choose to receive their health care benefits from certain private insurers called Medicare Advantage Organizations, instead of directly from the federal government.4 42 U.S.C. §§1395w-21 to -29; see also Aetna, 52 F.4th at 70. The MA Program is designed to “allow [Medicare] beneficiaries to have access to a wide array of private health plan choices in addition to traditional fee-for-service Medicare” and to “enable the Medicare program to utilize innovations that have helped the private market contain costs and expand health care delivery options.” H.R. Rep. No. 105-217, at 585 (1997). Under Medicare Part C, MAOs contract individually with the Centers for Medicare and Medicaid Services (“CMS”) within the Department of Health and Human Services for CMS to pay the MAO a fixed amount for each Medicare beneficiary who enrolls with the MAO, and for the MAO, in return, to provide at least the same benefits and services that the enrollee would receive under Medicare. See 42 U.S.C. §1395w-22(a). Increasingly since the debut of the MA Program, Medicare beneficiaries have elected to receive their Medicare benefits through MAOs.5 The MA Program imports many MSP Act provisions into the MAO context. As relevant here, the MA Program adopts the MSP Act’s secondary payer regime. See 42 U.S.C. §1395w-22(a)(4). In the MAO context, the MAO (instead of Medicare) is the secondary payer. If a primary plan “has not made or cannot reasonably be expected to make” prompt payment, the MAO may conditionally pay for the enrollee’s medical services in expectation of reimbursement by the primary payer. Id. §1395y(b)(2)(B)(i); see also id. §1395w-22(a)(4). When a primary plan is ultimately determined to be responsible for a cost but fails to reimburse an MAO for the MAO’s conditional payment, the MAO may sue the primary plan for damages under the MSP Act’s private cause of action. Aetna, 52 F.4th at 73-75; see also 42 U.S.C. §1395y(b)(3)(A). C. The Section 111 Reporting Requirement In a provision often known simply as Section 111,6 the MSP Act requires that primary plans report to CMS certain claims they receive so that CMS may “make an appropriate determination concerning coordination of benefits, including any applicable recovery claim.” 42 U.S.C. §1395y(b)(8)(B)(ii). If a primary plan violates Section 111, it is exposed to liability for “a civil money penalty of up to $1,000 for each day of noncompliance with respect to each claim.” Id. §1395y(b)(8)(E)(i). Section 111 provides in relevant part: (8) Required submission of information by or on behalf of liability insurance (including self-insurance), no fault insurance, and workers’ compensation laws and plans (A)…[A]n applicable plan shall — (i) determine whether a claimant (including an individual whose claim is unresolved) is entitled to benefits under the program under this subchapter on any basis; and (ii) if the claimant is determined to be so entitled, submit the information described in subparagraph (B) with respect to the claimant to the Secretary in a form and manner (including frequency) specified by the Secretary. (B) Required information… — (i) the identity of the claimant for which the determination under subparagraph (A) was made; and (ii) such other information as the Secretary shall specify in order to enable the Secretary to make an appropriate determination concerning coordination of benefits, including any applicable recovery claim. … (C) Timing Information shall be submitted under subparagraph (A)(ii) within a time specified by the Secretary after the claim is resolved through a settlement, judgment, award, or other payment (regardless of whether or not there is a determination or admission of liability). … (G)… (i)…The Secretary may share information collected under this paragraph as necessary for purposes of the proper coordination of benefits. II. Factual Background As alleged in the amended complaint, the facts are as follows.7 Hereford provides no-fault insurance to its policyholders. When a policyholder is a Medicare beneficiary, Hereford’s no-fault policy is a primary plan under the MSP Act. MSP is a litigation and technology firm that “own[s] and pursu[es] claims” arising under government healthcare programs on behalf of healthcare organizations and providers, including MAOs. Jt. App’x 66. MSP is not itself an MAO, but its assignors are.8 Health Insurance Plan of Greater New York, an EmblemHealth company (“EmblemHealth”) and an MAO, is alleged to be one of MSP’s assignors. MSP seeks double damages in this putative class action for what it describes as Hereford’s “deliberate and systematic avoidance of payment and/or reimbursement obligations” under the MSP Act. Id. at 33 (Am. Compl. 7). It contends that Hereford failed to reimburse EmblemHealth and the proposed class of MAOs for conditional payments made by the MAOs for medical expenses incurred by Medicare beneficiaries enrolled with the MAOs and that Hereford, as the primary plan, was required to pay under its no-fault insurance policies. MSP now identifies only one set of facts that it asserts exemplifies this “deliberate and systematic avoidance”: that of the Medicare beneficiary “N.G.”9 It alleges that on October 14, 2014, N.G. was injured in an accident and required medical care as a result. At the time of the accident, N.G. was enrolled in an MA plan issued by the MAO EmblemHealth. N.G. was also covered by a no-fault policy issued by Hereford. For medical services provided to N.G. between October 14 and October 18, EmblemHealth was billed $9,085.15 and paid $2,694.15. Hereford reported N.G.’s medical services to CMS under Section 111. By reporting these services to CMS, MSP alleges, Hereford admitted “that it should have paid for N.G.’s accident-related injuries in the first instance.” Id. at 43 (Am. Compl.
