UnitedHealthcare claims in a new federal lawsuit that American Renal Associates, a publicly traded dialysis company, engaged in a scheme to switch patients from Medicare and Medicaid coverage to UnitedHealthcare coverage to greatly boost payments, the New York Times reported.
In its suit, filed in the Southern District of Florida, the insurer says the American Kidney Fund, a not-for-profit patient assistance group funded by dialysis companies, paid the patients' premiums for private insurance. American Renal Associates allegedly “earmarked donations” to the kidney fund to pay for the coverage, violating anti-kickback laws.
Dialysis centers say they lose money on Medicare and Medicaid patients and rely heavily on higher-paying commercial insurance patients to make up the losses.
American Renal Associates told the Times the lawsuit was without merit. The American Kidney Fund, which was not named as a defendant, declined to comment on the specifics suit but said it was “deeply troubled” by the allegations of “improper use” of its program.
The suit may revive concerns by insurers and regulators about third-party payment for the private insurance premiums of people with serious health conditions. The fear is that healthcare providers and affiliated groups are paying the premiums to boost revenues. But providers argue that paying premiums so patients have coverage is good for patients' health.
Insurance regulators in Idaho and Minnesota recently announced that insurers could decline third-party premium payments from organizations such as the American Kidney Fund.
UnitedHealthcare says in its suit that American Renal Associates billed out-of-network prices of about $4,000 per dialysis treatment, much higher than the $200 paid by the Florida Medicaid program.
American Renal Associates has reported that payments by private insurers cover 13% of the treatments it providers but make up 40% of its operating revenue.