DaVita targeted Medicaid-eligible patients with private plan information

DaVita HealthCare Partners contacted Medicaid-eligible dialysis patients with private insurance enrollment information. The organization says the information was meant to educate patients, while a report from the St. Louis Post-Dispatch raised questions about the company's motivations.

Commercial insurance, which was often denied to patients with end-stage renal disease before the ACA eliminated preexisting conditions, typically has higher reimbursement for dialysis treatment than Medicaid. In Missouri, the state Medicaid program reimburses $122.94 per dialysis treatment, while private insurers can reimburse as much as $4,000 per treatment, according to the report.

Internal emails obtained by St. Louis Post-Dispatch from open enrollment 2016 show DaVita told Medicaid-eligible patients their monthly premiums for private insurance would be covered by the American Kidney Fund, a nonprofit to which DaVita contributes. DaVita's outreach included helping patients complete applications for private health plans and American Kidney Fund's assistant program, as well as sending brochures explaining the "additional" coverage's increased transplant, physician and out-of-state treatment access.  

The Denver-based company's internal emails dubbed the outreach the "Medicaid Opportunity," according to the report. Employees' progress with Medicaid patient outreach and patient interest was tracked. 

However, DaVita denies it pressured patients toward private health plans, but rather said it was educating patients. "DaVita does not steer patients toward any particular insurance option or plan. DaVita educates its patients so that they are able to make informed decisions that are in their best interest," Philipp Stephanus, a company senior vice president, said in a statement, according to St. Louis Post-Dispatch.

Less than 30 of DaVita's more than 3,000 Missouri patients signed up for private coverage.

In August CMS said it is considering rules to stop healthcare providers who are seeking higher reimbursements from steering patients toward ACA individual health plans over Medicare or Medicaid. The agency sent warning letters to Medicare-enrolled dialysis centers and requested public comment.  

More articles about payer issues:
Idaho insurers up financial stakes for out-of-network care
Anthem changes HMO, PPO offerings in Kentucky
How California health plans fare on quality and patient experience: 9 things to know

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