UnitedHealth accuses dialysis provider of overbilling scheme

Hundred dollar bills

UnitedHealth Group Inc. has filed a lawsuit against American Renal Associates Holdings Inc. (ARA), claiming the provider recruited patients with kidney disease by paying their insurance premiums so it could bill the insurer for dialysis services at an elevated rate.

In the complaint filed last week, UnitedHealth accused ARA of “systematically” convincing Medicare- and Medicaid-eligible patients with end-stage renal disease to obtain coverage with the insurer. Although government plans reimbursed $200-$300 for each dialysis session, the suit claims ARA used its out-of-network status with UnitedHealth’s commercial plans to bill as much as $4,000 for the same services.

In order to convince patients to switch to UnitedHealth’s coverage, the insurer says ARA recruited the American Kidney Fund to pay the premiums of the more expensive commercial plans in exchange for “earmarked donations” made by ARA. UnitedHealth claims the provider “maximized profits” by steering patients toward plans that would pay the highest dialysis reimbursement and waived copays, coinsurance and deductibles.

UnitedHealth included a list of charges from 27 different patients in Florida and Ohio from March 2016 through May 2016 that listed claims as high as $4,473 for one outpatient dialysis visit. ARA submitted more than $2.2 million in claims for those patients, and UnitedHealth paid out more than $1.9 million.

ARA denied the charges, and the American Kidney Fund--which wasn't named in the lawsuit--declined to comment, according to the Wall Street Journal.

The claims reignited longstanding concerns about whether third parties should be permitted to pay insurance premiums. Although the Department of Health and Human Services initially discouraged hospitals and health systems from paying for premiums in 2013, then-HHS Secretary Kathleen Sebelius quickly clarified that insurers must accept premium payment from certain entities, including charity organizations, an issue that insurers classified as a “conflict of interest.”

UnitedHealth is seeking an injunction that will stop ARA from continuing the practice of paying for premiums, along with unspecified damages.

- check out UnitedHealth’s complaint
- here's the list of charges
- read the Wall Street Journal article