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California lawmaker calls for OIG to rescind advisory opinion for American Kidney Fund, to conduct probe
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Rep. Katie Porter of California is asking the Office of Inspector General of the HHS to rescind an advisory opinion for the American Kidney Fund’s Health Insurance Premium Program governing its practice of providing premium assistance to patients on dialysis and then conduct an investigation into whether dialysis providers and the AKF are pushing patients toward more expensive insurance options to increase dialysis center profits.
“I’m calling for a thorough investigation into these abusive practices to make sure that large dialysis companies aren’t lining their pockets at patients’ expenses,” Porter said in a press release.
The relationship between dialysis providers — Porter specifically names Fresenius Medical Care, DaVita Kidney Care and American Renal Associates in her request to the OIG for the probe — and the AKF’s Health Insurance Premium Program (HIPP) offering premium assistance to patients on dialysis has been reviewed by CMS and by other California legislators since 2016, and was the subject of a failed ballot initiative last year. Revised legislation introduced in January 2019 has already passed the House and is now in the Senate in California that would cap payments from commercial health plans to dialysis providers for treatments at Medicare rates if third-party payers like the HIPP cover insurance premiums for patients.
Porter, however, said a federal investigation is needed into the relationship between the AKF and the dialysis providers and the OIG should suspend its opinion allowing the HIPP to operate until the investigation is concluded.
“Patients and clinicians had reported that two of the nation’s largest dialysis providers are using their financial influence over the American Kidney Fund to push patients into unaffordable coverage options and are discouraging patients from getting transplants,” she said.
In a statement, AKF President and CEO LaVarne A. Burton, said, “OIG Advisory Opinion 97-1 under which we operate protects patients by ensuring they have choice in their insurance coverage and in their choice of providers, not just for dialysis but for all their complex medical needs. Patients apply to us for assistance with their health insurance coverage already in place. We adamantly agree with Rep. Porter that patients should never be steered into plans that are not right for them, and that’s why our charitable premium assistance program, as required by 97-1, maintains a firewall between the providers who contribute to AKF and the patients who receive our assistance.”
References:
www.kidneyfund.org/news/news-releases/akf-statement-in-response-to-rep-porters-press-release.html