National dialysis provider American Renal Associates has agreed to pay UnitedHealthcare $32 million to resolve allegations of patient steering and overbilling.
It’s the second such lawsuit that ARA has settled this year. In February, the company agreed to pay $4 million to resolve a shareholder class-action lawsuit, which alleged the fraud investigation caused the price of the company's shares to drop.
As part of the settlement, UnitedHealth agreed to “renew and/or not terminate” the network agreement it ended with “Joint Venture providers” dating back to August 1, 2017. UnitedHealthcare and ARA also inked a three-year agreement, making the dialysis company an in-network provider in 26 states and the District of Columbia.
"We are pleased to have reached a resolution on this matter and we look forward to building a more cooperative relationship that enables us to collaborate on high quality care for dialysis patients,” the companies said in a joint statement.
Court filings show that the relationship has been anything but cooperative over the last several years. The settlement resolves lawsuits filed in Florida and Massachusetts. UnitedHealth’s first complaint, filed in Florida in July 2016, accused ARA of diverting Medicare and Medicaid patients with end-stage renal disease to higher reimbursement Affordable Care Act plans through a premium assistance program.
The second suit, filed in March in the U.S. District Court in Massachusetts, added new allegations that ARA used joint venture agreements to induce nephrologists to send patients to out-of-network ARA dialysis clinics. The suit also alleged that ARA routed premium assistance payments through the American Kidney Fund (AKF) to keep patients on commercial plans.
"The American Kidney Fund was not a party to the lawsuit and therefore we have no comment on the settlement," AKF said in a statement to FierceHealthcare. "At the time it was filed we objected to the inflammatory and false mischaracterization by UnitedHealthcare of AKF and our federally approved Health Insurance Premium Program. Our focus has always been on the patients we help and ensuring that they have access to the healthcare they need to stay alive."
Last year, ARA revealed it received a subpoena from the Justice Department regarding its interactions with AKF. Two other large, publicly traded dialysis companies—Fresenius Medical Care and Davita—also received subpoenas about premium assistance.
Premium assistance has been a focal point for insurers which see it as a loophole in the ACA that allows organizations to steer patients to higher reimbursement plans. In turn, AKF has accused insurers of steering dialysis patients toward government plans.