Major insurer UnitedHealth is filing a suit against American Renal Associates in The U.S. District Court for the Southern District of Florida for allegedly submitting fraudulent bills since the beginning of 2016, according to The New York Times.
Here are seven key points:
1. UnitedHealth is claiming nonprofit patient advocacy group American Kidney Fund helped American Renal Associates, a company that operates almost 200 U.S. dialysis clinics, in the billing scheme. In the suit, the payer is seeking to recoup the money it lost in the alleged fraudulent billing worth millions.
2. In the suit, UnitedHealth claims American Renal Associates "earmarked donations" to American Kidney Fund to help pay for coverage, which was in violation of anti-kickback laws. Additionally, the suit claims American Renal Associates did not inform their patients the fund would cease paying their premiums if the patient had a kidney transplant.
3. American Renal Associates Vice President and General Counsel Michael R. Costa said, "At all times, we are dedicated to putting patients first, and we structure all of our relationships within that framework."
The American Kidney Fund did not offer a comment regarding the lawsuit's specific allegations, but did say the fund was "deeply troubled" by UnitedHealth's claims. American Kidney Fund's LaVarne A. Burton, chief executive, said the fund did not recommend specific facilities or payers to its patients, and almost 66 percent of the patients receiving help from the fund were on Medicare.
4. In the suit, UnitedHealth alleges American Renal Associates moved their patients over to private plans by finding poor patients in Florida's rural areas who did not have access to a nearby dialysis clinic within the payer's network. After identifying those patients, American Renal Associates allegedly recommended those patients switch to UnitedHealth plans, and would use American Kidney Fund's program to help patients pay their premiums.
5. American Renal Associates contended it does depend on private payers to pay for treatments. Private payers cover only 13 percent of the treatments clinics provide, yet those payments comprise 40 percent of American Renal Associates' revenue.
6. So far this year, UnitedHealth claims it has paid American Renal Associates nearly $2 million.
7. Various federal and state regulators have voiced their concerns over outside groups making payments to payers whose aim is likely to make huge profits, as opposed to helping patients. A top Idaho insurance regulator said this week payers could refuse outside payments from organizations such as the American Kidney Fund. Dean L. Cameron, director of the Idaho Department of Insurance, said while some companies aim to help people, some payments are worrisome when the funding is directly tied to the physician or facility administering care.
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