- UnitedHealth Group has filed suit against dialysis provider American Renal Associates Holdings Inc., alleging fraud over its efforts to help consumers cover premiums for private health policies, The Wall Street Journal reported.
- The insurer argued ARA schemed to get patients who were eligible for Medicare or Medicaid to instead sign up with UnitedHealth and use charity money to cover the premiums, all so ARA could file for UnitedHealth's larger reimbursements.
- According to the lawsuit, ARA received $300 or less per dialysis session for patients enrolled in government programs but billed UnitedHealth about $4,000 per session.
UnitedHealth's case illustrates the general industry dispute around the subject of third-party payment of health plan premiums, which has received little guidance under the ACA, The Wall Street Journal noted.
While some providers are incentivized to cover some patients' premiums in order to receive payment for their services, insurers have argued that assistance from providers or affiliated charities tends to go to patients requiring high levels of care, therefore raising premiums for everyone else.
HHS has been a bit ambiguous on the subject, having suggested in 2013 that insurers reject premium payments from providers, but later adding that advice did not apply to some entities such as independent nonprofits that “do not consider enrollees’ health status.”
The ARA argued the UnitedHealth lawsuit is without merit, and the American Kidney Fund -- the charity involved in the case -- told the Journal six insurers in 34 states have begun rejecting their payments.
Some states have addressed the issue with varying results; Louisiana and North Carolina support such third-party payments while Minnesota and Idaho have specified insurers don't have to accept them.