Full opinion text
ANDERSON, Circuit Judge: This case grows out of the 1995 settlement of a class-action products liability suit against manufacturers of silicone breast implants. The settlement resulted in the creation of a reimbursement mechanism by which several settling manufacturers agreed to cover certain health care expenses incurred by or on behalf of qualified members of the plaintiff class. The Government, as intervenor, sought to recover for medical bills it paid on behalf of Medicare beneficiaries who received treatment related to silicone breast implants. The district court dismissed the Government’s Complaint in intervention for failure to state a claim. We conclude that the dismissal was in error. We therefore reverse and remand. I. BACKGROUND A. Historical Background The underlying case is result of an order by the Judicial Panel on Multi-District Litigation, which consolidated all then-pending products liability claims against the manufacturers of silicone breast implants into a single action before the United States District Court for the Northern District of Alabama. The exact details of the underlying claims are not of significance to the disposition of the appeal before us. It is enough to observe that, in general, the plaintiffs allege that they suffered, or fear that they will contract, a variety of systemic illnesses traceable to silicone breast implants, necessitating in some instances that the implants be surgically removed at considerable expense. The litigation resulted in a settlement valued at $4.2 billion that initially involved eight defendant manufacturers (the “Lindsey settlement”). On September 1, 1994, after conducting a fairness hearing, the district court approved the terms of the Lindsey settlement, with modifications. See In re Silicone Gel Breast Implant Litig., No. CV 92-P-10000-S, MDL No. 926, Civ. A. No. CV94-P-11558-S, 1994 WL 578353 (N.D.Ala. Sept. 1, 1994) (approving modified settlement and redefining parameters of class membership). Subsequently, one of the larger defendants, Dow Corning, declared bankruptcy, and several other defendants (apparently dissatisfied with the court-imposed modifications) chose not to participate in the settlement, leaving the following companies as appellees now before us: Baxter International, Inc.; Bristol-Myers Squibb Co., Minnesota Mining and Manufacturing Co. (“3M”); Union Carbide Corp.; and Union Carbide Chemical & Plastics Co. After the modifications were publicized to class members, and after the settlement was restructured to take account of Dow Coming’s bankruptcy filing, the district court gave final approval to the settlement by order of December 22, 1995. This became known as the “Revised Settlement Program,” or RSP. The participating implant manufacturers are referred to collectively as “the RSP Defendants,” the ap-pellees before us. The revised settlement class covered personal injury or death claims by members of a class consisting of: persons who received silicone breast implants before June 1, 1993; all children born to mothers with breast implants before April-1, 1994; and their spouses or other relatives. The Government, as well as a number of private insurers, moved to intervene prior to approval of the settlement for purposes of asserting claims for reimbursement of medical claims paid on behalf of class members. The district court denied these motions as premature. Its order stated, in pertinent part: “The court will consider these issues at a later time, before any distributions ... are made, and hopefully on the basis of motions that in some appropriate manner identify the persons on whose behalf subrogation claimants have paid medical expenses, rather than simply assert a general claim against the class.” In accordance with the settlement, the RSP Defendants created a Claims Office to review the documentation submitted by prospective class members and determine what level of benefits, if any, applicants were eligible to receive. Also as part of the claims process, the district court appointed an Escrow Agent, who is responsible for overseeing the investment and disbursement of the settlement proceeds. The position has been held since its inception by Edgar C. Gentile, III. The district court granted the Escrow Agent, as an agent of the court, “judicial immunity” for actions taken in his quasi-judicial capacity, unless he acts in the clear absence of jurisdiction. The settlement resulted in the creation of two funds relevant to this case. The principal fund, called the RSP Settlement Fund (or sometimes MDL 926 Settlement Fund) is the account from which claims are paid. The second, the Common Benefit Fund, was created by a surcharge on the RSP Defendants for purposes of paying legal fees and expenses incurred for the “common benefit” of all claimants. Both funds are administered by the Escrow Agent. The RSP Defendants made their first payment into the settlement fund in January of 1996, and at the direction of the district court, the Escrow Agent began issuing settlement payments to class members in mid-1996. According to the Government’s Complaint, about 81,000 claimants had received some payment from the RSP as of April 1999. To date, more than 400,000 women have registered as potential claimants, and the RSP Defendants have paid more than $1 billion into the RSP Settlement Fund. More than 52,000 breast implant recipients opted out of the settlement class, according to the Complaint, and the Defendants have made payments outside the RSP process to an unspecified number of them. It is not clear from the record to what extent the RSP Defendants carried liability insurance coverage (other than “self insurance,” about which more will be said shortly) for the events giving rise to the class members’ claims, or to what extent these defendants have received compensation from such insurance for payments made into the two settlement funds. It is apparent that the implant companies had at least some liability coverage, because the settlement agreement expressly provides for the Defendants’ insurers to have access to the otherwise confidential records of class claimants. We therefore take as established for purposes of this appeal that some third-party insurance coverage exists. Beginning in 1995 and continuing through March of 2000, the Government entered into a series of “tolling agreements” with the RSP Defendants while negotiating over the Government’s access to information about the settlement participants, for purposes of determining which class members may have received Government health benefits for which the Government was entitled to reimbursement. Under these tolling agreements, the Defendants agreed that they would not argue laches, statute of limitations or similar “timeliness” defenses if the Government was forced to file suit. In exchange, the Government agreed to forego filing suit during settlement negotiations. Negotiations between the Government and the RSP Defendants did not produce an agreement. Consequently, in March of 2000, the Government filed the complaint in intervention giving rise to this appeal. B. The Medicare Secondary Payer (MSP) Statute The Government’s Complaint initially relied on two distinct but related statutes and their accompanying regulations: (1) the Medicare Secondary Payer (“MSP”) statute, 42 U.S.C. § 1395y(b), and (2) the Medical Care Recovery Act (“MCRA”), 42 U.S.C. § 2651. Although all of the Government’s claims were dismissed, it is appealing only the dismissal of the MSP claim. The MSP is actually a collection of statutory provisions codified during the 1980s with the intention of reducing federal health care costs. See Zinman v. Shalala, 67 F.3d 841, 845 (9th Cir.1995) (“The transformation of Medicare from the primary payer to the secondary payer with a right of reimbursement reflects the overarching statutory purpose of reducing Medicare costs.”); Provident Life & Accident Ins. Co. v. United States, 740 F.Supp. 492, 498 (E.D.Tenn.1990) (“The intent of Congress in shifting the burden of primary coverage from Medicare to private insurance carriers was to place the burden where it could best be absorbed.”). In a nutshell, the MSP declares that, under certain conditions, Medicare will be the secondary rather than primary payer for its insureds. Consequently, Medicare is empowered to recoup from the rightful primary payer (or from the recipient of such payment) if Medicare pays for a service that was, or should have been, covered by the primary insurer. Although the statute is structurally complex. — a complexity that has produced considerable confusion among courts attempting to construe it — the MSP’s function is straightforward. As we explained in Cochran v. HCFA, 291 F.3d 775, 777 (11th Cir.2002): [I]f payment for covered services has been or is reasonably expected to be made by someone else, Medicare does not have to pay. In order to accommodate its beneficiaries, however, Medicare does make conditional payments for covered services, even when another source may be obligated to pay, if that other source is not expected to pay promptly. Medicare originated as a series of amendments to the Social Security Act enacted in 1965, providing a source of payment for hospital care for those over 65. The program was, for the most part, the primary source of payment for its beneficiaries even when another source of coverage existed. However, the 1965 amendments also provided that coverage would be secondary to workers’ compensation benefits, and that any payment to or on behalf of a Medicare beneficiary eligible for workers’ compensation benefits would be contingent upon reimbursement. See S.Rep. No. 404 § 1862, 89th Cong., 1st Sess. (1965), reprinted at 1965 U.S.C.C.A.N. 1965, 2127-28 (“no payment may be made ... for any item or service for which payment has been made, or can reasonably be expected to be made, under a workman’s compensation law or plan of the United States or a State. Any payment ... with respect to any [such] item or service must be conditioned on reimbursement being made to the appropriate trust fund for such payment if any when notice or other information is received that payment for such item or service has been made under such a law or plan.”); see also Parkview Hosp., Inc. v. Roese, 750 N.E.2d 384, 388 (Ind.Ct.App.2001) (discussing early history and evolution of MSP statute). That language became the template for the modern MSP provision. In pertinent part, the MSP statute in its current form provides: (A) In general Payment under this subchapter may not be made, except as provided in sub-paragraph (B), with respect to any item or service to the extent that— ... (ii) payment has been made or can reasonably be expected to be made promptly (as determined in accordance with regulations) under a workmen’s compensation law or plan of the United States or a State or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no-fault insurance. In this subsection, the term “primary plan” means ... a workmen’s compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan) or no fault insurance, to the extent that clause (ii) applies. (B) Repayment required (i) Primary plans Any payment under this subehapter with respect to any item or service to which subparagraph (A) applies shall be conditioned on reimbursement to the appropriate Trust Fund established by this subchapter when notice or other information is received that payment for such item or service has been or could be made under such paragraph. (ii) Action by United States In order to recover payment under this subchapter for such an item or service, the United States may bring an action against any entity which is required or responsible under this subsection to pay with respect to such item or service (or any portion thereof) under a primary plan (and may, in accordance with paragraph (3)(A) collect double damages against that entity), or against any other entity (including any physician or provider) that has received payment from that entity with respect to the item or service, and may join or intervene in any action related to the events that gave rise to the need for the item or service. (iii) Subrogation rights The United States shall be subro-gated (to the extent of payment made under this subchapter for such an item or service) to any right under this subsection of an individual or any other entity to payment with respect to such item or service under a primary plan. 42 U.S.C. § 1395y(b)(2)(A)-(B). Subpara-graph (b)(3)(A), which is referenced above, provides for a private right of action, with double damages available, if a primary plan “fails to provide for primary payment (or appropriate reimbursement) in accordance with” the preceding MSP regulations. See 42 U.S.C. § 1395y(b)(3)(A). Pursuant to these provisions of the MSP statute, HHS has enacted regulations setting forth the means by which the Government can bring an action to recoup payments from a primary coverage plan. These regulations read, in pertinent part: If a Medicare conditional payment is made, the following rules apply: (a) Release of information. The filing of a Medicare claim by or on behalf of the beneficiary constitutes an express authorization for any entity, including State Medicaid and workers’ compensation agencies, and data depositories, that possess information pertinent to the Medicare claim to release that information to CMS. This information will be used only for Medicare claims processing and for coordination of benefit purposes. (b) Right to initiate recovery. CMS may initiate recovery as soon as it learns that payment has been made or could be made under workers’ compensation, any liability or no-fault insurance, or an employer group health plan ... ...(e) Recovery from third parties. CMS has a direct right of action to recover from any entity responsible for making primary payment. This includes an employer, an insurance carrier, plan, or program, and a third party administrator ... ... (g) Recovery from parties that receive third party payments. CMS has a right of action to recover its payments from any entity, including a beneficiary, provider, supplier, physician, attorney, state agency, or private insurer that received a third party payment. (h) Reimbursement to Medicare. If the beneficiary or other party receives a third party payment, the beneficiary or other party must reimburse Medicare within 60 days. (i) Special rules. (1) In the case of liability insurance settlements and disputed claims under employer group health plans and no-fault insurance, the following rule applies: If Medicare is not reimbursed as required by paragraph (h) of this section, the third party payer must reimburse Medicare even though it has already reimbursed the beneficiary or other party. 42 C.F.R. § 411.24. Additionally, the regulations define “prompt” or “promptly,” when used in connection with third-party payments, to mean “payment within 120 days after receipt of the claim.” 42 C.F.R. § 411.21. The MSP, in its present form, originated with enactment of the Omnibus Budget Reconciliation Act (“OBRA”) of 1980, Pub. L. No. 96-499, § 958, 94 Stat. 2599 (1980). OBRA amended the Medicare Act to provide that Medicare payments “may not be made with respect to any item or service to the extent that payment has been made, or can reasonably be expected to be made (as determined in accordance with regulations) ... under an automobile or liability insurance policy ... or under no fault insurance.” Since enacting the MSP statute, Congress has expanded its reach several times, making Medicare secondary to a greater array of primary coverage sources, and creating a larger spectrum of beneficiaries who no longer may look to Medicare as their primary source of coverage. More significantly for our purposes, Congress has repeatedly clarified and augmented the Government’s powers to recoup conditional Medicare payments from primary sources. The Deficit Reduction Act (“DERFA”) of 1984 conferred on the Government a direct right of action to recover its payments from any entity “which would be responsible for payment” under a “law, policy, plan or insurance,” and provided that the Government would be subrogated to the right of any individual or entity to receive payment. DERFA also modified the original wording of the secondary payment provision by adding the modifier “promptly,” so that the pivotal phrase dictated that a Medicare payment “may not be made with respect to any item or service to the extent that payment has been made, or can reasonably be expected to be made promptly ... with respect to such item or service, under a workman’s compensation plan or plan of the United States or a State or under an automobile or liability insurance policy or plan (including a self-insured plan) or no-fault insurance[.]” H. Res. 4170, 98th Cong., 2d Sess., 98 Stat. 494 (1984) § 2344. In OBRA 1986, Congress added the private right of action for double damages codified at 42 U.S.C. § 1395y(b)(3)(A). It also added the cross-reference to that section in § 1395(b)(2)(B)(ii), which enables the Government to collect double damages “in accordance with” the new private right of action. H. Res. 5300, 99th Cong., 2d Sess., 100 Stat. 1874 (1986) § 9319. II. THE DECISION BELOW The Government’s Complaint advanced nine counts: (1) a claim for reimbursement against the RSP Defendants as third-party payers under the MSP; (2) double damages against the RSP Defendants as third-party payers under the MSP; (3) single damages under the MSP against the RSP Defendants as entities that caused payments to be made, or received such payments, from product liability insurers; (4) a subrogation claim under the MSP against disbursements from the MDL Settlement Fund and/or the Common Benefit Fund; (5) a claim for declaratory relief that the RSP Defendants are liable under the MSP to reimburse Medicare for past payments to breast implant patients, and are obligated under 42 C.F.R. § 411.25 to provide Medicare with notice of all payments to Medicare beneficiaries; (6) a single damages claim under the MSP against the Escrow Agent as a person who received payment from the RSP Defendants and/or from product liability insurers to pay the claimants; (7) a claim for injunc-tive relief under the MSP to enjoin the Escrow Agent from making disbursements to Medicare patients pending resolution of Medicare’s MSP claims and to compel disclosure of identifying information concerning all past or contemplated settlement payments to Medicare beneficiaries; (8) a claim for injunctive relief similar to Count VII under the MCRA, and (9) a demand under the MCRA for payment from the MDL Settlement Fund of the Government’s reasonable costs for paying for care of Medicare patients for injuries alleged to be caused by a breast implant. Thus, Counts I through VTI arose under the MSP or its regulations, while counts VIII and IX arose under the MCRA. The district court (after first granting the Plaintiffs’ Steering Committee the right to intervene) granted the motions to dismiss filed by the RSP Defendants, the Escrow Agent, and the Plaintiffs’ Steering Committee, finding that the Government had failed to state a claim upon which relief could be granted. The court first evaluated whether the Government had a claim for reimbursement under 42 U.S.C. § 1395y(b), the MSP statute. The court found that — whether the Government was bringing a direct action in its own right under the statute or was acting as the subrogee to the patient’s rights — an essential element to state a claim under the MSP was to identify both the services provided and the patient who received them. In addition to the need for the Defendants to know the identity of the patients and the amount in dispute, the court noted that the beneficiaries themselves are interested parties and have the right to challenge the reimbursement request and to petition the Government to waive its claim. The court rejected the Government’s argument that it was unable to plead the identity of the beneficiaries in question because of the settlement’s confidentiality provisions. The court found that the Defendants were under no statutory duty to collect information about the identity of potential claimants, and that absent such a duty, it was irrelevant whether the settlement was structured with the purpose of evading disclosure. Because the Government had an alternative means of relief— like any other insurer, it could file a petition for reimbursement with the RSP Claims Office — the court found no need to reheve the Government from compliance with the MSP statute or the pleading standards of Fed.R.Civ.P. 8(a). Next, the court considered whether the Government was entitled to reimbursement under 42 C.F.R. § 411.24(i), the “double payment” regulation adopted pursuant to the MSP. Under § 411.24®, a “third party payer” may be required to reimburse Medicare if it paid a provider or a claimant when it knew, or should have known, that Medicare had made a conditional primary payment as provided by the MSP. The district court found this regulation inapplicable, because the relevant portion of the MSP statute applies only to insurers or “self-insured plans.” The court rejected the Government’s contention that the implant manufacturers could be viewed as “self-insured plans.” The RSP Defendants were thus outside the coverage of the statute and not subject to the “double payment” regulation. Further, the court found that the Government had no direct right of action against a third-party payer that had already made payment to its insured, because such a payer was no longer “required or responsible ... to pay” as provided by the MSP statute, § 1395y(b)(2)(B)(ii). The Government may proceed against such an insurer only in its role as subrogee, the court held. Relying on Health Ins. Ass’n of America v. Shalala, 23 F.3d 412 (D.C.Cir.1994) (“HIAA”), and on general principles of common law, the court held that, as a subrogee, the Government was required to “plead and prove [that] the third-party payer knew or should have known of Medicare’s conditional payments at the time payment was made to the beneficiary.” Because, in the district court’s view, the Government failed to do so, its claims under the “double payment” provision were fatally flawed. The court declined to adopt the Government’s interpretation that the existence of the MSP statute itself puts insurers on constructive notice that they must inquire into whether Medicare has paid a beneficiary before they pay a claim. Rather, citing HIAA, the court held that “knowledge” requires the Government to show that, at the time it paid the claim, the insurer had “direct information ... or information necessary to draw the conclusion” that Medicare had made a conditional payment to the particular recipient. It was insufficient, the court held, that the Government’s prior intervention in the case generally alerted the Defendants that Medicare might have paid some claims. The court rejected the Government’s contention that the Defendants’ knowledge was a factual matter to be proven at trial. The court observed that the Government’s own complaint alleged that the RSP Defendants “did not ascertain” whether Medicare had made payments on behalf of any of the RSP claimants. With that assertion, the court felt that the Government had effectively pled itself out of court. Next, the court addressed whether the Government could bring a claim in Count II against the RSP Defendants for double damages pursuant to 42 U.S.C. § 1395y(a)(3)(A) and 42 C.F.R. § 411.24(c)(2). Having held that the Defendants were not hable even for single damages, the district court summarily rejected the Government’s claim for double damages. Similarly, the district court summarily rejected the Government’s claims for declaratory relief (Count V) and injunctive relief (Count VII). The court then considered whether any of the defendants could be hable under the MSP as entities that “received payment,” as provided in 42 U.S.C. § 1395y(b)(2)(B)(ii). (Although the court acknowledged that the Government’s claim under this section ran against both the RSP Defendants and the Escrow Agent, its discussion focused almost exclusively on the role of the Escrow Agent.) First, the court — again relying on HIAA— held that a mere “pass-through” could not be said to have “received” payment under any ordinary understanding of that term, since “receipt” suggests a degree of autonomous control. Further, the court observed that the term “recover” in the statute suggested that the Government must proceed against an entity actually in possession of the money — either the ultimate payer or the ultimate payee — and not an entity that temporarily held the money and relinquished it. Additionally, the court observed that the Defendants did not fit either the statute’s or HHS regulations’ illustration of who qualifies as an entity that receives payment: the statute uses the illustration “any physician or provider,” while 42 C.F.R. § 411.24(g) refers to “a beneficiary, provider, supplier, physician, attorney, State agency or private insurer that has received a third party payment.” All of those entities, the court observed, are likely to be ultimate recipients of payment rather than mere conduits. Where an entity has merely remitted payment as a pass-through, the court held, that entity is reachable only through 42 C.F.R. § 411.24(f), which requires proof of knowledge of Medicare’s prior payment that is lacking in this case. III. DISCUSSION We review a district court’s grant of a motion to dismiss for failure to state a claim de novo. ABATE of Georgia, Inc. v. Georgia, 264 F.3d 1315, 1315 (11th Cir.2001). A motion to dismiss a complaint in intervention is reviewed under the same standard applicable to consideration of a motion to dismiss the original plaintiffs’ complaint. Southwest Ctr. for Biological Diversity v. Berg, 268 F.3d 810, 819-20 (9th Cir.2001). In evaluating the sufficiency of a complaint under Rule 12(b)(6), courts must be mindful that the Federal Rules require only that the complaint contain “a short and plain statement of the claim showing that the pleader is entitled to relieff.]” Fed.R.Civ.P. 8(a). In applying Rule 12(b)(6), “a complaint should not be dismissed for failure to state a claim unless it appears beyond a doubt that the [complainant] can prove no set of facts in support of his claim which would entitle him to relief.” Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 102, 2 L.Ed.2d 80 (1957). The district court granted the motion on two grounds: first, that the Government’s Complaint was defective because it did not include the identity of the recipients of federal health care benefits and the nature of the expenditures, and second, that the MSP statute did not entitle the Government to proceed on its chosen theories against these defendants. Thus, we must consider both whether the Government has viable claims under the applicable law, and, if so, whether the Government’s pleading was sufficient to invoke the MSP. A. Sufficiency of Complaint The district court held that, “at a minimum,” a complaint under the MSP statute must identify the Medicare beneficiaries for whose care reimbursement is sought. Because the Complaint here failed to do so, the court held, the MSP counts were subject to dismissal. Because the Federal Rules embody the concept of liberalized “notice pleading,” a complaint need contain only a statement calculated to “give the defendant fair notice of what the plaintiffs claim is and the grounds upon which it rests.” Conley, 355 U.S. at 47, 78 S.Ct. at 103; see also Caribbean Broad. Sys., Ltd. v. Cable & Wireless PLC, 148 F.3d 1080, 1086 (D.C.Cir.1998) (“[A] plaintiff need not allege all the facts necessary to prove its claim.”). We have observed that the threshold of sufficiency to which a complaint is held at the motion-to-dismiss stage is “exceedingly low.” See In re Southeast Banking Corp., 69 F.3d 1539, 1551 (11th Cir.1995) (“[F]or better or for worse, the Federal Rules of Civil Procedure do not permit district courts to impose upon plaintiffs the burden to plead with the greatest specificity they can.”). Rule 24 requires merely that an intervenor’s petition “shall state the grounds [for intervention] and shall be accompanied by a pleading setting forth the claim or defense for which intervention is sought.” Fed.R.Civ.P. 24(e). “The determination of whether the proposed intervenor’s complaint states a cause of action is controlled by the general rules on testing a pleading; the factual allegations of the complaint are assumed to be true ... and the pleading is construed liberally in support of the pleader.” Pin v. Texaco, Inc., 793 F.2d 1448, 1450 (5th Cir.1986) (internal quotes and citation omitted); accord County of Santa Fe v. Public Serv. Co. of N.M., 311 F.3d 1031, 1035 (10th Cir.2002). The Supreme Court has said in the context of a standing determination that “[a]t the pleading stage, general factual allegations of injury resulting from the defendant’s conduct may suffice, for on a motion to dismiss we presume that general allegations embrace those specific facts that are necessary to support the claim.” Nat’l Org. for Women, Inc. v. Scheidler, 510 U.S. 249, 256, 114 S.Ct. 798, 803, 127 L.Ed.2d 99 (1994) (quoting Lujan v. Defenders of Wildlife, 504 U.S. 555, 561, 112 S.Ct. 2130, 2137, 119 L.Ed.2d 351 (1992)). In Swierkiewicz v. Sorema, N.A., 534 U.S. 506, 511, 122 S.Ct. 992, 997, 152 L.Ed.2d 1 (2002), the Court held that in the employment discrimination context, a complaint is not subject to dismissal for failure to state a claim merely because it fails to “plead facts establishing a prima facie case” of discrimination. As the Court emphasized there: The liberal notice pleading of Rule 8(a) is the starting point of a simplified pleading system.... Rule 8(a) establishes a pleading standard without regard to whether a claim will succeed on the merits. “Indeed, it may appear on the face of the pleadings that a recovery is very remote and unlikely but that is not the test.” Id. at 514, 122 S.Ct. at 999 (quoting Scheuer v. Rhodes, 416 U.S. 232, 236, 94 S.Ct. 1683, 40 L.Ed.2d 90 (1974)). Courts typically allow the pleader an extra modicum of leeway where the information supporting the complainant’s case is under the exclusive control of the defendant. See Peters v. Amoco Oil Co., 57 F.Supp.2d 1268, 1284-85 (M.D.Ala.1999) (holding that complaint setting forth general allegations about nature of conspiracy was sufficient despite heightened pleading standard applicable to conspiracy claims under Fed.R.Civ.P. 9(b), where information about extent of alleged conspiracy was within defendants’ exclusive control); see also Quality Foods de Centro America, S.A. v. Latin American Agribusiness Dev. Corp., 711 F.2d 989, 995 (11th Cir.1983) (holding that liberalized consideration of complaint espoused in Conley “is particularly true in an antitrust suit where the proof and details of the alleged conspiracy are largely in the hands of the alleged co-conspirators.”). The situation presented here— an intervenor bringing a claim on the basis of injury to a large group of others, the identities of whom the intervenor claims cannot be determined without discovery— is not unlike that commonly presented in a class action, such as the one that underlies our case. In a class action, it is sufficient that a complaint generally give the defendant notice of the nature and scope of the plaintiffs’ claims; it is not necessary that the class representatives plead evidence or otherwise meet any burden beyond the minimal Rule 8 standard. See 7B WRIght, MilleR & Kane, Federal Practice & Procedure § 1798 (2d ed. 1986) at 417-18 (“All of the pleading provisions of the federal rules are applicable in class actions and operate in much the same fashion as they do in other litigation contexts.... No greater particularity is necessary in stating a claim for relief in a class action than in other contexts.”); Alba Conte & Herbert B. Newberg, 6 Newberg on Class Aotions § 18:46 (4th ed. 2003) (“It is not necessary ... that class members be specifically identified; the plaintiff need not name names. In addition, the complaint need not set forth the exact number of class members. It is sufficient to indicate the approximate size of the class and provide or describe facts making ultimate identification of class members possible when that identification becomes necessary.”). Indeed, the Supreme Court’s seminal statement of the standard for dismissal, Conley, involved a class action by African-American railroad clerks who alleged that their union had breached its duty of fair representation by discriminating against them. In view of the foregoing, we find that the district court applied too exacting a standard when it found the Government’s Complaint fatally deficient for failing to identify each member of the plaintiff class on whose behalf Medicare made a conditional payment. The crucial information that the district court here found necessary to complete the Government’s Complaint — “the Medicare beneficiaries who have received benefits from the defendants” — is outside the Government’s control. At best, the Government may be able to generate a list of all patients who received treatment for breast implant-related medical conditions during the period covered by the RSP settlement. Such a list would be wildly over-inclusive, as it could include: patients whose implants were not manufactured by any of the RSP Defendants; patients who had their implants removed for reasons other than tor-tiously inflicted injury; patients who opted not to participate in the settlement; and patients participating in the class whose application for RSP benefits may (for whatever reason) not be approved by the Claims Office so that they will never receive payment. The Government could not in good faith purport to be bringing its Complaint on behalf of such a patently inaccurate list of beneficiaries. See Fed. R.Civ.P. 11(b) (“By presenting to the court ... a pleading, written motion, or other paper, an attorney or unrepresented party is certifying that to the best of the person’s knowledge, information, and belief, formed after an inquiry reasonable under the circumstances ... the allegations and other factual contentions have evidentiary support”). While the Government might be able to arrive at a rough approximation, the RSP Defendants (either directly or through the Claims Office) have access to: (1) the names of the approximately 400,000 registered potential claimants, and (2) the approximately 81,000 people whose claims, to date, have been deemed worthy of payment. They are, consequently, in the far more advantageous position to compile an accurate list of Medicare patients for whom MSP payments have been made or requested. The pleading standards urged by the RSP Defendants are akin to the heightened requirements of Fed.R.Civ.P. 9, which apply to claims of fraud, mistake, duress and other “special matters.” Where Rule 9 is implicated, plaintiffs must plead not only the general nature of their injuries but also the specifics of how and when they were injured. See, e.g., Brooks v. Blue Cross & Blue Shield of Florida, Inc., 116 F.3d 1364, 1380-81 (11th Cir.1997) (under Rule 9(b), plaintiff alleging fraud must plead “(1) the precise statements, documents, or misrepresentations made; (2) the time, place, and person responsible for the statement; (3) the content and manner in which these statements misled the Plaintiffs; and (4) what the defendants gained by the alleged fraud”); Coffey v. Foamex L.P., 2 F.3d 157, 161-62 (6th Cir.1993) (Rule 9(b) requires plaintiff in fraud ease “at a minimum, to allege the time, place, and content of the alleged misrepresentation on which he or she relied; the fraudulent scheme; the fraudulent intent of the defendants; and the injury resulting from the fraud”). By implication, then, a complaint governed by the ordinary standard of Rule 8 — and there is no dispute that Rule 8 applies here — need not allege the particulars of each instance of injury in order to survive a motion to dismiss. It is significant here that, out of a class of 400,000 potential claimants, it appears beyond dispute that at least some class members will have received conditional Medicare payments. No one suggests to the contrary. Therefore, given the benefit of discovery, it appears not only possible but in fact inevitable that the Government will turn up a number of claims eligible for reimbursement. That the Government cannot now provide a name, date and dollar amount corresponding to any particular Medicare payment for which reimbursement is owed does not indicate beyond doubt that it has “no case,” which is what a court must find to grant a motion to dismiss. Finally, we note that requiring the Government to plead with the specificity Defendants seek would run counter to the intent of the MSP statute. In carrying out its principal purpose of shifting the burden of paying for health care from Medicare to private insurers, the MSP creates as a practical matter a need for insurers to determine, before paying a disputed liability claim (involving among its alleged damages medical expenses likely to have been paid by Medicare), whether the Government has made a conditional payment, upon peril of being forced to pay the same claim twice. As the second payer, such insurer is in a position to determine which claim has been, or is at risk of being, paid twice, while Medicare, as the first payer, is not. Because the statute is built on the recognition that Medicare frequently will not know which of its payments has been subsequently duplicated by an insurer, it would — in this unique setting of a class action involving thousands of claimants — ■ defeat the purpose of the statute to require that the Government identify each patient, procedure, and payment amount at the pleading stage without benefit of discovery. We readily conclude that the district court erred in dismissing the complaint for failure to identify the beneficiaries for whose care reimbursement is sought. B. Scope of MSP Statute 1) Were Medicare’s payments conditioned on reimbursement? The RSP Defendants argue here that the Government’s right to recoup its payments never arose, because under the terms of the MSP statute, Medicare’s payments were not “conditional” at all. The disputed statutory provisions, 42 U.S.C. §§ 1395y(b)(2)(A) and (b)(2)(B), provide: (A) In general Payment under this subchapter may not be made, except as provided in subparagraph (B), with respect to any item or service to the extent that— (i) payment has been made, or can reasonably expected to be made, with respect to the item or service as required under [regulations governing group health plans], or (ii) payment has been made or can reasonably be expected to be made promptly (as determined in accordance with regulations) under a workmen’s compensation law or plan of the United States or a State or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no-fault insurance.... In this subsection, the term “primary plan” means a group health plan or large group health plan, to the extent that clause (i) applies, and a workmen’s compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan) or no fault insurance, to the extent that clause (ii) applies. (B) Repayment required (i) Primary plans Any payment under this subchapter with respect to any item or service to which subparagraph (A) applies shall be conditioned on reimbursement to.the appropriate Trust Fund established by this subchapter when notice or other information is received that payment for such item or service has been or could be made under such paragraph. Defendants argue that subparagraph (A) operates as a limitation on the right of reimbursement in subparagraph (B), so that a Medicare payment is conditioned on reimbursement only if “payment has been made or can reasonably be expected to be made promptly” by another insurer. In other words, Defendants argue that Medicare is entitled to reimbursement only if Medicare pays after payment from a primary insurance source either has already been made or is expected promptly. Otherwise, in Defendants’ view, Medicare’s payment is unconditional and may not be recouped. Grammatically, Defendants’ interpretation is a possible reading of the statute. However, we think the much more plausible interpretation of the statute is that Medicare would endeavor not to pay where a “primary plan” has paid or is expected to pay promptly, but any payment that Medicare does make is secondary and is subject to reimbursement from sources of primary coverage under the statute. This more plausible interpretation is also a grammatically correct construction of the language of the statute. The crucial phrase in § 1395y (b) (2) (B) (i) — “to which subpara-graph (A) applies” — plausibly modifies “any item or service,” meaning any item or service covered by a primary plan as defined in the last paragraph of § 1395y(b)(2)(A). The court in Brown v. Thompson, 252 F.Supp.2d 312, 317 (E.D.Va.2003) recently rejected Defendants’ interpretation, and adopted the interpretation we adopt today. The Broum court held: [T]he reference in subparagraph B to “item or service to which subparagraph A applies” must refer only to that portion of subparagraph A that defines a primary plan. In other words, the reference to subparagraph A in subpara-graph B serves simply to define the universe of reimbursable payments to consist of those where primary coverage exists.... Properly construed, therefore, subparagraph B requires reimbursement for a payment, as here, that “has been made” from a “primary plan” as defined in subparagraph A. It is clear that an item or service paid by a primary plan defined in the last paragraph of subparagraph (A) is, in the language of subparagraph (B), an “item or service to which subparagraph (A) applies.” In other words, subparagraph (A) applies by defining the universe of reimbursable payments. Our interpretation is further supported by a close examination of the language of subparagraphs (A) and (B). Subpara-graph (B) refers to payments “with respect to any item or service to which subpara-graph (A) applies.” This would include any payments contemplated by subpara-graph (A). Turning to subparagraph (A) to ascertain what payments it contemplates, we see that it contemplates that Medicare should not pay if payment has been made or is reasonably expected from a group health plan (subparagraph (A)(i)), and that Medicare should not pay if payment has been made or can reasonably be expected to be made promptly under plans including liability insurance or self-insured plans (subparagraph (A)(ii)). By contrast subparagraph (A) clearly contemplates Medicare will pay when it does not reasonably expect prompt payment by such primary obligors — precisely the payments which Defendants argue are not reimbursable. We believe that the much more plausible interpretation of the statutory language indicates that these payments are reimbursable. These are payments “with respect to any item or service to which subparagraph (A) applies” because subparagraph (A) defines their universe and contemplates Medicare paying them. Although only our more plausible interpretation comports with the purpose of the statute, see infra, the two grammatically correct potential interpretations mean that the statute might be considered ambiguous. Where such ambiguity exists, the reasonable interpretation of the agency charged with implementing the statute is entitled to judicial deference, under the principles enumerated by the Supreme Court in Chevron USA, Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984). The first step in the two-step Chevron review is to determine whether Congress has “directly and unambiguously spoken to the precise question at issue.” Georgia Dept. of Med. Assistance v. Shalala, 8 F.3d 1565, 1567 (11th Cir.1993) (“Georgia DMA”) (quoting Chevron, 467 U.S. at 842-43, 104 S.Ct. at 2781-82). If so, the court’s inquiry is at an end, for it must honor Congress’ clearly expressed intent. Determining whether Congress has unmistakably addressed the issue requires looking at “the particular statutory language at issue, as well as the language and design of the statute as a whole.” Georgia DMA, 8 F.3d at 1567 (citing Sullivan v. Everhart, 494 U.S. 83, 89, 110 S.Ct. 960, 964, 108 L.Ed.2d 72 (1990)). If Congress has not directly addressed the issue, or the statutory provision is ambiguous, we come to the second stage of Chevron: whether the agency’s construction of the statute is reasonable and consistent with congressional intent. If so, we must accede to it. See Dawson v. Scott, 50 F.3d 884, 887 (11th Cir.1995) (“Agency interpretation is reasonable and controlling unless it is ‘arbitrary, capricious, or manifestly contrary to the statute.’ ”) (quoting Chevron, 467 U.S. at 844, 104 S.Ct. at 2782); Bigby v. INS, 21 F.3d 1059, 1063 (11th Cir.1994) (“[W]e defer to an agency’s reasonable interpretation of a statute it is charged with administering.”). The consistency of an agency’s interpretation over time is a factor in determining the level of deference due. Good Samaritan Hosp. v. Shalala, 508 U.S. 402, 417, 113 S.Ct. 2151, 2161, 124 L.Ed.2d 368 (1993); see also Teamsters v. Daniel, 439 U.S. 551, 566 n. 20, 99 S.Ct. 790, 800 n. 20, 58 L.Ed.2d 808 (1979) (“It is commonplace in our jurisprudence that an administrative agency’s consistent, longstanding interpretation of the statute under which it operates is entitled to considerable weight.”). Here, we find that HHS — which was expressly delegated by Congress to formulate rules implementing the MSP statute— has consistently taken the position that Medicare payments are conditional and subject to recoupment regardless of whether another insurer can be expected to render a prompt primary payment. We start with the agency’s notion of what it means for a Medicare payment to be “secondary.” HHS regulations state that “ ‘[secondary,’ when used to characterize Medicare benefits, means that those benefits are payable only to the extent that payment has not been made and cannot reasonably be expected to be made under other insurance that is primary to Medicare.” 42 C.F.R. § 411.21. In other words, the regulation rejects Defendants’ interpretation, and embraces our interpretation — that conditional medical payments are made to beneficiaries whose primary coverage has not yet paid and is not expected to pay promptly. In updating its regulations to account for congressional revisions in 1984 through 1987, the agency stated its understanding that “Medicare makes conditional primary payment only if the other insurer will not pay promptly.” Medicare as Secondary Payer and Medicare Recovery Against Third Parties, 53 Fed. Reg. 22335, 22336 (proposed June 15, 1988). Similarly, in characterizing Congress’ 1987 revisions to the secondary payment provisions regarding coverage for end-stage renal patients, HHS stated: “Medicare may not make conditional primary payments on behalf of an ESRD beneficiary who is covered by an employer group health plan if the plan ‘can reasonably be expected’ to pay.” Medicare as Secondary Payer and Medicare Recovery Against Third Parties, 54 Fed. Reg. 41716, 41717 (Oct. 11, 1989); see also Medicare Program, Services Covered Under Automobile Medical, No-Fault, or Liability Insurance; Services Furnished to ESRD Beneficiaries Who Are Covered Under Employer Group Health Insurance, 48 Fed. Reg. 14802, 14807 (April 5, 1983) (“Congress clearly intended that Medicare not pay first when there is a reasonable expectation that the employer plan will pay as promptly as Medicare.... Medicare will be primary payer for items and services not covered by the employer plan and will make conditional primary payments if the intermediary or carrier determines that the employer plan will not pay promptly.”). These and other authoritative HHS interpretations evidence that the agency has always understood that it will endeavor not to make payments where a payment has already been made by, or can reasonably be expected to be made by, a primary insurer, but that payment may be made conditionally under § 1395y(b)(2)(B) when Medicare does not reasonably expect prompt primary coverage payment. We find the agency’s interpretation to be in accord with the structure, history and purpose of the MSP statute, all of which plainly indicate that Congress wanted Medicare’s payments to be secondary and subject to recoupment in all situations where one of the statutorily enumerated sources of primary coverage could pay instead. It is readily apparent that the interpretation evidenced in the HHS regulations, which we also adopt, correctly implements the statutory purpose. The RSP Defendants do not deny that the clear statutory purpose of the Medicare Secondary Payer statute was to make Medicare’s obligation secondary to that of designated primary obligors, with the intention of reducing federal health care costs. This statutory purpose is universally accepted. It is also clear that HHS’ interpretation would fulfill the congressional purpose, while Defendants’ interpretation would frustrate that purpose. Next we turn from the foregoing general purpose of the statute to the specific language which Defendants argue supports their interpretation: “Any payment under this subchapter with respect to any item or service to which subparagraph (A) applies shall be conditioned on reimbursement .... ” § 1395y(b)(2)(B)(i). Defendants argue that subparagraph (A) refers to situations where the primary obligor has already paid or can be expected to pay promptly; thus, Defendants argue that Medicare payments are conditional only in such situations. However, subparagraph (A) makes it clear that those are the very situations in which Medicare should endeavor not to pay. Thus, Defendants’ interpretation would require us to indulge the illogical premise that Congress intended for Medicare to pay claims that it knew for a fact had already been paid, or were about to be paid, by the primary obligor— the very claims which the statute clearly contemplates that Medicare would endeav- or not to pay. Thus, both the general statutory purpose, and the purpose evident in the very language upon which Defendants rely, is manifestly inconsistent with Defendants’ interpretation. By contrast, our interpretation, and that adopted by the regulations, fully implements the general congressional purpose, and is consistent with both the purpose and the precise language of §§ 1395y(b)(2)(A) and (B). In our view, Congress intended that Medicare would always be secondary to the sources of primary coverage enumerated in the statute. Our interpretation not only fulfills the statutory purpose, but is consistent with the congressional intent as evidenced in the legislative history. Congress quite clearly expressed its understanding of how the secondary payment mechanism was designed to work in 1984, when enacting amendments that clarified the Government’s direct and subrogatory rights against third-party payors: The bill establishes the statutory right of medicare [sic] to recover directly from a liable third party, if the beneficiary himself does not do so, and to pay a beneficiary, or on the beneficiary’s behalf pending recovery where such third party is not expected to pay promptly. H.R.Rep. No. 98-432, at 1803 (1984), reprinted in 1984 U.S.C.C.A.N. 697, 1417 (emphasis added). Unmistakably, Congress intended that contingent payments made because the primary payer was not expected to pay promptly would be subject to recovery. The legislative history of the MSP indicates that it originated as a device to recoup payments from automobile insurance coverage. See Mason v. American Tobacco Co., 212 F.Supp.2d 88, 93 (E.D.N.Y.2002) (quoting original House bill, which referred only to “automobile insurance”). It is not at all uncommon for automobile insurance claims to be litigated and thus to take more than 120 days to be resolved. See, e.g., Waters v. Farmers Texas County Mut. Ins. Co., 9 F.3d 397 (5th Cir.1993) (denying summary judgment on MSP claim arising out of automobile accident three years earlier and remanding case for trial). The same is true of workers’ compensation claims, which have been included within the scope of the MSP since its inception. Indeed, Medicare regulations specifically contemplate recovery where the third-party payment is the result of a judgment or a litigation settlement, which as a practical matter will almost always take more than 120 days. See 42 C.F.R. § 411.37 (providing that Medicare will deduct from its recovery a pro rata share of attorney fees and other “procurement expenses” incurred to secure a judgment or settlement). Congress fully contemplated such delays when it provided for Medicare to pay contingently. See H.R.Rep. No. 1167, 96th Cong., 2d Sess., at 389 (1980) (“Medicare will ordinarily pay for the beneficiary’s care in the usual manner and then seek reimbursement from the private insurance carrier after, and to the extent that, such carrier’s liability under the private policy for the services has been determined.”). If the Defendants’ interpretation were correct, it could well preclude recovery from automobile liability or workers’ compensation insurance — the very sources for which the MSP was designed— since those sources routinely pay claims more than 120 days after the provision of medical treatment. The historical evolution of these statutory provisions also supports the interpretation adopted by the agency. When Congress expanded the secondary payer provision in the Omnibus Budget Reconciliation Act of 1981 so that it would include those enrolled in federal employee health plans and end-stage renal patients covered by group health plans, the provision read as follows: (2)(A) In the case of an individual who is entitled to benefits under [Medicare] part A or is eligible to enroll under part B ... payment under this title may not be made, except as provided in subpara-graph (B), with respect to any item or service furnished during the period described in subparagraph (C) to the extent that payment with respect to expenses for such item or service (i) has been made under any group health plan ... or (ii) the Secretary determines will be made under such a plan as promptly as would otherwise be the case if payment were made by the Secretary under this title. (B) Any payment under this title with respect to any item or service to an individual described in subparagraph (A) during the period described in sub-paragraph (C) shall be conditioned on reimbursement to the appropriate Trust Fund established by this title when notice or other information is received that payment for such item or service has been made under a plan described in subparagraph (A). See H. Res. 3982, 97th Cong., 1st Sess., 95 Stat. 357 (1981) (emphasis added). Thus, in the 1981 version, it is clear that subpar-agraph (B) incorporates subparagraph (A) only to indicate that the two subpara-graphs apply to the same set of individuals■ — those entitled to benefits under Medicare Part A or eligible to enroll in Medicare Part B — not to the same set of payments. In the Tax Equity and Fiscal Responsibility Act of 1982 (TERFA), Congress revised the MSP provision so as to make Medicare the secondary payer for “working aged” recipients under age 70 and their spouses enrolled in employer group health plans. TERFA added the following conditional payment provision to 42 U.S.C. § 1395y: (3)(A)(i) Payment under this title may not be made, except as provided in clause (ii), with respect to any item or service furnished ... to an individual who is over 64 but under 70 years of age ... who is employed at the time such item or service is furnished to the extent that payment with respect to expenses for such item or service has been made, or can reasonably be expected to be made, under a group health plan ... (ii) Any payment under this title with respect to any item or service ... shall be conditioned on reimbursement to the appropriate Trust Fund ... when notice or other information is received that payment for such item or service has been made under a group health plan. H. Res. 4961, 97th Cong., 2nd Sess., 96 Stat. 324 (1982) (emphasis added). The conditional payment provision, in this iteration, patently applied to any item or service for which a group health plan might pay. It in no way limited the Government’s right of recovery to those items or services for which a third-party payment was made or reasonably anticipated before Medicare made its payment. Congress again amended the MSP in 1986 with the purpose, inter alia, of prohibiting employer group health plans from offering lesser benefits to senior citizens based on their Medicare eligibility. At that point, the “secondary payer” provision read: (4)(A)(i) A large group health plan may not take into account that an active individual is eligible for or receives benefits under this title ... (ii) Payment may not be made under this title, except as provided in clause (iii), with respect to any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to the item or service as required under clause (i). (iii) Any payment under this title with respect to any item or service to which clause (i) applies shall be conditioned on reimbursement to the appropriate Trust Fund established by this title. See H. Res. 5300, 99th Cong., 2nd Sess., 100 Stat. 1974 (1986). In this incarnation, Medicare’s right of reimbursement in sub-paragraph (A)(iii) (what is now subpara-graph (B)) refers back to and incorporates subparagraph (A)(i), which concerns the duty of large group health plans to render primary payment. Again, this version makes clear that the reference to subpara-graph (A) in Medicare’s right of reimbursement merely characterizes the broad category of coverage to which Medicare will be secondary. It cannot possibly be read as limiting Medicare’s right of recovery to payments made after a group health plan has already paid or is expected to pay. The current wording of the MSP was adopted as part of the Omnibus Budget Reconciliation Act of 1989, H. Res. 8299, 101st Cong., 1st Sess., 108 Stat. 2186 (1989). There is no indication in the legislative history that, between 1986 and 1989, Congress changed its mind and decided that Medicare should cease being the secondary payer for a substantial subset of claims. Although the 1989 amendments obscured the clarity of the prior versions of the conditional payment provision, we cannot glean from this obscurity an unambiguous legislative purpose to narrow the MSP in the way that Defendants urge. Our view is further sharpened by Congress’ addition of the modifier “promptly” in 1984. Defendants have offered no logical explanation, and we can discern none, for why Congress would have intended to divest Medicare of the right to pursue recovery if payment from another insurer was probable, yet — because of a coverage dispute — unlikely to occur within the 120-day window of “promptness.” Rather, it is apparent that the concern for “promptness” is motivated by a desire to prevent either the health care provider or the patient from going without compensation for a prolonged period while an insurance dispute is being resolved. Indeed, that is exactly how Congress — in enacting an earlier iteration of the MSP — explained its insertion of the term “promptly” i