I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: Zach on August 19, 2016, 12:56:52 AM
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American Renal seeks dismissal of United Healthcare lawsuit
http://www.nephrologynews.com/american-renal-seeks-dismissal-united-healthcare-lawsuit/?utm_source=newsletter_081816&utm_medium=email&utm_campaign=newsletter&mkt_tok=eyJpIjoiTkdOaU1ESTFPRE0yWVRoayIsInQiOiJiVzFpMElzc2tVQlN6WUY5MXdDakZveWZBclhDV09Zc0QxdUgwdHBJZmhxTElxbTdiTUFMcTNBSFwvTlFZTFdnWTdnVG1XUkFFXC94V1Y2MnN3emlLMVVBajRKT2xDUnJUSVJXWnNyb2I4a2prPSJ9
MARK E. NEUMANN — AUGUST 16, 2016
Attorneys representing American Renal Associates Holdings have filed a request in a U.S. District Court in Southern Florida to dismiss a lawsuit filed by United Healthcare over charges of pushing dialysis patients into UHC plans in order to collect higher payments.
The complaint, filed July 1 in the Southern District of Florida, is “filled with generalized, conclusory statement, misleading half-truths, and material omissions,” says the filing released on Aug 12 by Kobre & Kim LLP of Miami. “…Indeed, it is apparent that United manufactured this lawsuit by making payments in amounts it was not contractually obligated to make. It did so in an effort to justify dropping coverage for chronically ill, low income patients with the pre-existing condition of end-stage renal disease, who require dialysis as an essential life-sustaining treatment and who enrolled in one of its insurance plans.”
In the 39-page complaint, United said ARA launched a “fraudulent and illegal scheme … to unlawfully obtain benefit payments from United for dialysis services rendered to vulnerable patients suffering from chronic kidney disease.” The complaint identifies 27 dialysis patients treated at 12 ARA clinics that United said joined the insurer’s Gold Compass 1500 plan in Florida and its Compass and Navigate Plan in Ohio. United said some of the patients would have qualified for Medicare. “…Many of the patients ARA counseled into dropping Medicaid coverage and switching to a United commercial plan … were also eligible for Medicare coverage at the time they were enrolled in the United plans by ARA employees.”
In addition, it charges in the suit that ARA told patients it would pick up any charges for co-pays or deductibles once they agreed to sign onto the commercial plans.
In a statement, ARA defended its practices.
“At all times, we are dedicated to putting patients first, and we structure all of our relationships within that framework and with the intent to provide patients with the best possible service and quality of care,” said Michael Costa, vice president and general counsel of American Renal Associates Holdings Inc. “We believe this lawsuit is without merit. We intend to vigorously defend this legal action for American Renal and on behalf of all patients who choose and trust us with their care.”
ARA, which went public in April, operates 201 clinics and serves 13,755 patients across 25 states and the District of Columbia. Thirty-nine of those clinics are in Florida.
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See related article:
United Healthcare sues American Renal over excessive charges, pushing patients into lucrative commercial plans
http://www.nephrologynews.com/united-healthcare-sues-american-renal-excessive-charges/
United Healthcare, the largest insurer in the country, filed a lawsuit against American Renal Associates on July 1, charging that the country’s fifth largest provider convinced Medicaid patients to switch to more lucrative commercial insurance plans that paid the provider thousands of dollars more.
In the 39-page complaint, filed in the United States District Court in the Southern District of Florida, United said ARA launched a “fraudulent and illegal scheme … to unlawfully obtain benefit payments from United for dialysis services rendered to vulnerable patients suffering from chronic kidney disease.”
The complaint identifies 27 dialysis patients treated at 12 ARA clinics that United said joined the insurer’s Gold Compass 1500 plan in Florida and its Compass and Navigate Plan in Ohio. United said some of the patients would have qualified for Medicare. “…Many of the patients ARA counseled into dropping Medicaid coverage and switching to a United commercial plan … were also eligible for Medicare coverage at the time they were enrolled in the United plans by ARA employees.”
In addition, it charges in the suit that ARA told patients it would pick up any charges for co-pays or deductibles once they agreed to sign onto the commercial plans.
In a statement, ARA defended its practices.
“At all times, we are dedicated to putting patients first, and we structure all of our relationships within that framework and with the intent to provide patients with the best possible service and quality of care,” said Michael Costa, vice president and general counsel of American Renal Associates Holdings Inc. “We believe this lawsuit is without merit. We intend to vigorously defend this legal action for American Renal and on behalf of all patients who choose and trust us with their care.”
ARA, which went public in April, serves about 13,400 patients at 194 dialysis clinics in 25 states and the District of Columbia. Thirty-nine of those clinics are in Florida.
United: AKF’s premium payment program aided ARA’s efforts
United’s suit claims that ARA’s efforts to move patients to commercial plans were aided by the American Kidney Fund’s Health Insurance Premium Payment program, which helps needy patients cover their premiums. The AKF was not named as a defendant in the suit, but United said the AKF “…knew or should have known that the terms of the United commercial plans to which ARA endeavored to steer ESRD patients did not permit AKF or ARA to make premium payments for United plan members, or to contribute to or reimburse those members for their premium payments.”
Dialysis providers helped to create HIPP back in 1997 as a way to cover insurance premiums for dialysis patients. It was approved by the Office of Inspector General and allows the AKF to provide grant assistance by making premium payments on behalf of financially needy dialysis patients. The OIG did not limit the program to Medicare and Medicaid plans, allowing HIPP to cover premiums for Marketplace plans, COBRA, or an employer group health plan. The program currently benefits approximately 79,000 patients nationwide, the AKF says; nearly two-thirds of those individuals are getting help with their Medicare Part B and Medigap premiums.
“We help patients who are in financial need to pay for the coverage they have chosen. It doesn’t matter what kind of insurance they have or where they choose to get their care. Our job is to make sure they get the care they need despite their financial circumstances,” the AKF said in a statement.
In an interview with NN&I, AKF president and CEO Lavarne Burton said the OIG ruling requires the organization to maintain a pool for the funds given by providers, but checks are written to an insurer to cover a patient’s premium without being tied to a specific provider. The AKF also verifies that the patient meets criteria set by the HIPP for financial assistance.
“The companies who contribute to AKF will not be assured that the amount of HIPP assistance their patients receive bears any relationship to the amount of their donations,” the OIG ruling reads. “Indeed, the companies are not guaranteed that beneficiaries they refer to HIPP will receive any assistance at all. HIPP will not be advertised to the public by the companies; this should reduce the probability that a beneficiary would select a company based on its participation in HIPP.”
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Let me see if I understand this correctly.
An Insurance Com
pany is mad that they have to pay out claims?
Pretty much what I though all along.
Insurance Companies want to collect premium rates, and keep them but not paying out any claims.
So they employ whole teams of attorneys to constantly re-write policies, restricting coverage until one day they won't pay out anything at all.
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We really need to outlaw price discrimination and force everyone to have one price regardless of who is paying.
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An Insurance Com
pany is mad that they have to pay out claims?
Pretty much what I though all along.
Insurance companies are mad because they have to take patients who know, before the even apply, that they will be filing claims well in excess of the premium. This is not "spreading risk" but "income/asset redistribution". That is not a value statement for or against such policies, just an observation of fact.
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I have used my wife's insurance for the las 12 years. In January I was on dialysis for 33 months and switched to Medicare as primary. I kept my wife's insurance as secondary. In May my wife retired, she was entitled to keep her insurance but her company wanted its retirees eligible for Medicare to switch. They offered a enhanced Medicare advantage program if my wife switched to Medicare. Wonderful plan, they even pay for all medications in the donut hole. They get to pay Medicare rates and I and my wife get great coverage. A win win.