Dialysis Patient Citizens et al. v. Burwell et al.

Why this Matters:

The plaintiffs argue that an interim final regulation that tries to limit the ability of third parties to provide financial assistance to Medicare-eligible dialysis patients to purchase private health insurance violates the Medicare Act and Administrative Procedure Act. Patients with end-stage renal disease are eligible for insurance under Medicare. However, some organizations, including those funded heavily by the dialysis industry, pay premiums and out-of-pocket costs for patients so they can instead enroll in private health insurance coverage. This may offer some benefits to patients but also ensures that dialysis providers receive higher reimbursement rates since private insurers pay much higher rates than Medicare.

Potential Impact:

Steering Medicare-eligible dialysis patients to the commercial insurance market, where reimbursement rates are far higher, could raise premiums.