Lawsuit alleges fraud and conspiracy in scheme involving American Kidney Fund, dialysis patients.
Florida Blue filed a lawsuit in federal court against one of its kidney dialysis providers alleging the provider conspired with a nonprofit to cause Florida Blue to pay “tens of millions of dollars” for patient treatments that should have been covered by Medicaid or Medicare.
Blue Cross Blue Shield of Florida Inc. and Health Options Inc., collectively known as “Florida Blue,” brought the complaint against DaVita Inc., a national network of dialysis clinics registered in Delaware and headquartered in Denver.
DaVita did not respond to a request for comment.
The complaint alleges that DaVita conspired with the American Kidney Fund, a 501(c)(3) based in Rockville, Maryland to defraud Florida Blue.
The fund states on its website that it is “the nation's leading nonprofit working on behalf of the 30 million Americans with kidney disease.”
The complaint alleges that DaVita advised patients who were eligible for Medicaid and Medicare to instead enroll in Florida Blue plans so that DaVita could be paid more per treatment than it would have been paid by the government health care plans.
According to the lawsuit, DaVita made substantial donations to the nonprofit that the nonprofit then routed back to DaVita's patients in amounts calculated to cover their commercial insurance premiums, for which DaVita billed Florida Blue and was reimbursed at a higher rate per treatment than it would have been by the government insurance programs.
The complaint further alleges that, in violation of its provider agreement with Florida Blue and government regulations, DaVita routinely waived, eliminated or otherwise failed to collect its Florida Blue members' deductible, copayment and coinsurance obligations to ensure that patients would enroll in, or remain enrolled in Florida Blue plans and continue to be treated at DaVita facilities.
Florida Blue contends that in a single year, DaVita contributed $120 million to the American Kidney Fund to pay for Medicaid patients DaVita was treating to enroll in commercial health insurance plans and that DaVita received $450 million in operating income from benefits payments for services it provided to the patients with commercial insurance.
Charges made by Florida Blue against DaVita comprise breach of contract, good faith and fair dealing; interference with contract; fraud; negligent misrepresentation; civil conspiracy; unjust enrichment; and violation of the Florida Unfair and Deceptive Trade Practices Act.
Florida Blue is seeking compensatory and punitive damages and for the court to order DaVita to cease the practices cited in the complaint.
The lawsuit was filed Tuesday in Jacksonville by attorney Michael Abel of Abel Bean Law.
Florida Blue also is represented by Robins Kaplan, a law firm in Minneapolis.