UnitedHealth Sues American Renal Associates, Alleges Fraud to Inflate Profits
UnitedHealth Group Inc has sued national dialysis services provider American Renal Associates Holdings Inc, accusing the provider of engaging in an illegal scheme in order to receive larger payments for the services it provides.
The lawsuit claims that American Renal Associates convinced patients to sign up for UnitedHealth plans and connected them with a charity that would help pay the premium costs, even though the patients involved were eligible for Medicare or Medicaid coverage. According to the suit, American Renal Associates could receive much larger reimbursement payments for patients covered under UnitedHealth plans.
The Beverly, MA-based company operates roughly 200 dialysis clinics. The suit claims that American Renal Associates’ reimbursement from government programs was $300 or less per dialysis session than from the private insurer. UnitedHealth was billed roughly $4000 per dialysis session.
UnitedHealth, the largest insurer in the United States, is seeking unspecified damages and wants American Renal Associates to discontinue their practice.
Nonprofit organizations that assist patients on dialysis with paying their premiums were also cited in the lawsuit. The American Kidney Fund was cited specifically; according to the Wall Street Journal, six insurers from 34 states are no longer accepting payments from the group despite their strict guidelines to keep them independent from funders.
Most individuals receiving dialysis for advanced kidney disease are eligible for Medicare before turning the minimum age of 65 years. Low income patients may also qualify for Medicaid. UnitedHealth’s suit listed 27 unnamed patients whom the insurer claims American Renal Associates convinced to switch to UnitedHealth’s Affordable Care Act plans and to obtain premium aid from the American Kidney Fund.
American Renal Associates said in a statement that they intend to, “vigorously defend this legal action for American Renal and on behalf of all patients who choose and trust us with their care.”
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