DaVita—one of the two biggest providers of dialysis services in the US—is being accused by a former clinic nurse and doctor of intentionally wasting expensive medicine (.pdf; 365KB) in order to defraud Medicare. According to Andrew Pollack, writing for the New York Times, “The lawsuit says that the company, DaVita, used larger than necessary vials of medicine knowing that Medicare would pay for the unused portion of each vial if it were deemed unavoidable waste.”
Under the new Medicare rules, dialysis providers are paid a single, “bundled” fee for dialysis services, including all necessary intravenous drugs. But before January, when the new rules took effect, Daniel Barbir (the former DaVita nurse) and Alon Vainer (a doctor and former DaVita medical director) allege the company required nurses to use a 10 mcg vial of Zemplar, intravenous vitamin D, for a 6 mcg prescription (instead of three 2 mcg vials), billing Medicare for the 10 mcg vial and throwing away the unused 4 mcg. Similar practices were employed with Venofer, an iron drug.
Medicare has long paid only for the exact amount of Epogen actually administered, but Barbir and Vainer allege DaVita used and billed Medicare for every bit of Epogen, including excess amounts, called “overfill,” for which it did not pay.
DaVita spokesperson Bill Meyers tells Pollack, “the larger but fewer vials for Zemplar helped minimize needle sticks and protect patients and nurses from possible infection.” That would be plausible if it were true, but it’s not. All intravenous drugs administered during dialysis are given in the dialysis line, not the patient. Pollack could have easily researched this, but didn’t.
Meyers goes on to cite Pollack as telling him that small doses of Venofer “were thought to be better for the patient.” This is simply not true. Venofer (and similar iron drugs) must be administered slowly to some patients who are sensitive to the drug (myself included), but there is absolutely no evidence supporting the efficacy of smaller doses. With a simple Google search Pollack could have found this out, but failed again.
Barbir and Vainer provide documentation indicating a DaVita dialysis center in Georgia wasted twice as much Venofer as its patients received.
Disclosure: I’ve been a DaVita dialysis patient, carrying private insurance, for more than 11 years.
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