Executive Summary: Why Are Dialysis Providers Paying Your Members’ Premiums?

Executive Summary: Why Are Dialysis Providers Paying Your Members’ Premiums?

An alleged “pay-to-play” scheme from dialysis providers has recently come to light. According to a recently unsealed whistleblower complaint, dialysis providers have been paying members’ premiums through the American Kidney Fund (AKF).  Why is this important? If premiums are paid, dialyzing members may decide not to enroll in Medicare, losing important financial protections, and keeping them on plan coverage beyond the end of the Medicare coordination period. In addition, they may have been directed to higher-cost dialysis providers even if they prefer lower-cost nonprofit providers.

In a recent white paper, John R. Christiansen, Chief Legal Officer of Renalogic, breaks down the number of current legal actions surrounding this issue, including:

  • Two recent legal actions in Washington and Florida involving major plan providers
  • Requests from the Centers for Medicare and Medicaid Services regarding inappropriate steering of individuals eligible for or receiving Medicare and Medicaid Benefits to individual market plans
  • Details of a recently unsealed whistleblower complaint against the AKF, DaVita and Fresenius, alleging they created a pay-to-play scheme, which provided illegal remuneration to patients and created incentives to use only providers who contributed to AKF
  • A comprehensive overview of California legislature AB 290, a bill aimed at restricting dialysis provider profits and limiting the use of AKF

In the paper, John also discusses the market dynamics of large dialysis organizations and Medicare enrollment and claims issues for members on dialysis. In addition to the unfair financial gain for LDOs’ investment in AKF, John explains why this issue impacts self-insured plans and the serious consequences of guiding members away from Medicare.

To access the full paper, please click here to provide your contact information and a member of our team will send it to you.

Renalogic

Renalogic, headquartered in Phoenix, AZ, was founded in 2002 as a specialty dialysis cost-containment company to help clients understand the unique market dynamics in the dialysis provider community. The company has evolved to become a comprehensive provider of data-driven, end-to-end chronic kidney disease (CKD) care and cost management programs for the self-insured industry. Renalogic’s professional team includes leaders in healthcare administration, care management, legal specialists in ERISA and healthcare law, contract negotiation, payer/provider negotiation, and clinical experts.