Union urges state probe of dialysis industry health plan ‘scheme’

SEIU Healthcare Workers West has asked California’s Attorney General to investigate the health plan program of the nonprofit American Kidney Fund whose promotional photo is seen here. LINKED IN

OAKLAND, California – Health care workers are urging the California Attorney General’s office to investigate and halt the dialysis industry’s alleged scheme to steer low-income patients into health plans that may limit their ability to receive kidney transplants and access care after a transplant.

The Aug. 24 complaint filed on behalf of SEIU-United Healthcare Workers West with the Attorney General’s Office alleges that “under this scheme, operated through the nonprofit American Kidney Fund’s Health Insurance Premium Program, patients with End Stage Renal Disease (“ESRD”) are steered away from Medi-Cal or Medicare in favor of individual commercial insurance policies sold on Affordable Care Act (“ACA”) marketplaces, including Covered California.

“The Fund pays monthly premiums for ESRD patients, but, the evidence shows, only so long as they do not receive kidney transplants. Keeping ESRD patients on commercial insurance benefits the dialysis industry by allowing it to reap greater profits through charging commercial insurers exorbitant reimbursement rates.

The union’s complaint describes the program as an “exceptionally cynical … policy on funding for transplant care [that] reflects the priorities of a program designed not for patient care, but to promote the financial interests of dialysis facilities.” The complaint further alleges that the “steering scheme’s sole purpose is to provide this boon for the dialysis industry; no legitimate purpose is served.”

SEIU-United Healthcare Workers West says the American Kidney Fund, a non-profit organization, is backed by the dialysis industry. It alleges that approximately 80 percent of the American Kidney Fund’s revenue comes from the two-largest dialysis corporations, DaVita and Fresenius, “which made a combined $3.9 billion in profits from their dialysis operations in the United States last year.”

Advocates allege the American Kidney Fund’s program violates California Unfair Competition Law and charitable trust law, and is a kickback scheme in violation of federal law. They say the Attorney General must intervene to protect dialysis patients and keep premiums and costs down for all Californians covered by private health insurance.

A New York Times January 1 report on Justice Department subpoenas served to Fresenius and DaVita says the dialysis companies have denied that they inappropriately steered patients into signing up for private insurance.