UnitedHealth sues dialysis chain over $1.9M in payments

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UnitedHealth Group has filed suit against American Renal Associates, alleging the Beverly, Mass.-based dialysis chain engaged in a "fraudulent and illegal scheme" to maximize its own profits.

UnitedHealth claims ARA convinced patients to enroll in plans UnitedHealth sold on the Affordable Care Act exchanges instead of Medicare and/or Medicaid coverage. The insurer accuses ARA of connecting these patients with the American Kidney Fund to help pay their insurance premiums, according to The Wall Street Journal.

"The lone motivating factor behind ARA's patient conversion efforts is ARA's desire to maximize its own profits," the suit said.

According to the suit, the government reimburses the ARA $300 or less per dialysis session, while the ARA sought to bill UnitedHealth out-of-network prices of about $4,000 per treatment.

Like several other insurers, UnitedHealth has rules against accepting third-party premium payments such as those from the American Kidney Fund. The insurer claims it made about $1.9 million in improper payments to 12 ARA facilities due to the fraud scheme, according to a filing with the Securities and Exchange Commission by the ARA.

The ARA, which operates about 200 dialysis clinics, said UnitedHealth's lawsuit is without merit.

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