A payee is usually obligated to acknowledge payment by producing a receipt to the payer. Medicare is an ACO's primary payer. This effectively shifts the tax burden of alimony from the recipient to the payer. It is also the highest income tax payer in the private sector in India. Gabbard supports a universal health care plan called "Single Payer Plus". Chargeback is a return of money to a payer. Tavria-V is the biggest private company and the biggest tax payer. It is the primary payer of nursing home care. Chakraborty also became India's highest tax payer in 1986. In 2019, Carlucci sponsored and passed legislation known as the Toll Payer Protection Act.