Three times a week, people across Northeast Pennsylvania drive to a dialysis center, sit in a chair, and let a machine clean their blood for hours. They trust the staff. They trust the process. Most of them believe they’re waiting for a kidney transplant that will get them out of that chair for good.
What many of them don’t know is who’s actually running the show, and what that company has been caught doing, over and over again, with federal regulators and the courts.
The company is DaVita Inc. It controls 37% of the U.S. dialysis market, roughly 281,000 patients across more than 2,600 centers nationwide. Together with Fresenius, the only other major player, these two corporations control nearly 80% of the entire industry. There is, for most patients, no meaningful alternative.
DaVita operates at least eight facilities in Northeast Pennsylvania. And approximately 90% of its patients are on government-funded insurance, meaning American taxpayers are paying for this.
How Dialysis Became a Business
When your kidneys fail, your blood can no longer clean itself. A dialysis machine does the job instead. Since the 1970s, the federal government has heavily subsidized dialysis treatment through Medicare. For 2025, Medicare’s base payment rate is roughly $274 per treatment, and most patients receive dialysis three times a week, meaning a single patient generates tens of thousands of dollars in annual billing.
Dialysis is supposed to be temporary, a bridge while a patient waits for a kidney transplant, which dramatically improves both quality and length of life. The transplant waitlist is long, but the process starts with a referral. That referral is supposed to come from the patient’s care team.
For a company like DaVita, every occupied dialysis chair is revenue. Every session is a billable event. An empty chair is lost money. And a patient who receives a kidney transplant is, from a business standpoint, a lost customer.
Research published in the Clinical Journal of the American Society of Nephrology found that patients at for-profit dialysis facilities were 16% less likely to be referred for a transplant than patients at nonprofit facilities. For-profit patients also waited longer for referral, a median of 4.6 months versus 3.8 months. Separate research analyzing U.S. Renal Data System records found that among for-profit chains including DaVita and Fresenius, only 6.6% to 7% of patients were placed on the deceased-donor transplant waitlist, compared to nearly 30% at nonprofit independent facilities.
For many dialysis patients, especially lower-income ones on Medicare, the dialysis center becomes their primary healthcare relationship. The nephrologist overseeing their care is often employed by or contracted through the dialysis company. The social workers who should be assisting with transplant paperwork work for the company too. If that care team doesn’t prioritize transplant education, referral, and waitlist management, it simply doesn’t happen. The patient doesn’t know what they’re not being told.
What DaVita Has Been Caught Doing
DaVita is not a company that occasionally runs afoul of regulators. It is a company with a pattern. The following is a summary of its major federal settlements and legal actions:
2012: Paid $55 million to settle a whistleblower lawsuit alleging it double-billed Medicare for the anemia drug Epogen.
2014: Paid approximately $400 million to settle allegations it paid kickbacks to doctors in exchange for patient referrals to DaVita facilities. Of that, $350 million went directly to the federal government.
2015: Paid $495 million, the largest-ever False Claims Act settlement without government intervention, after whistleblowers revealed DaVita was deliberately wasting usable medication and billing Medicare and Medicaid for the discarded drugs. The scheme dated back to at least 2003.
2021: DaVita and its former CEO were criminally indicted by a federal grand jury for conspiring with competing healthcare companies to suppress employee wages through illegal no-poach agreements. A jury acquitted both in 2022, but a related civil class action remains active as of late 2024.
2024: Paid $34.5 million to settle allegations it violated the Anti-Kickback Statute by funneling referrals to DaVita Rx, its former pharmacy subsidiary. The whistleblower was DaVita’s own former Chief Operating Officer.
2024: Settled a class action for $3.8 million over secretly sharing patient data from its websites and apps with Facebook, Google, and other third parties without consent. The class covered more than 605,000 patients.
The running total in federal settlements alone approaches $1 billion.
Eight Locations in Your Backyard
Pennsylvania has more than 27,000 patients with end-stage renal disease. If DaVita’s national market share holds here, and there’s no reason to think it doesn’t, that’s roughly 10,000 Pennsylvanians whose kidney care runs through this company. Statewide, DaVita and Fresenius together likely handle around 21,000 of those patients. The industry has consolidated so aggressively that 32.5% of the U.S. population now lives in a hospital service area without access to a dialysis facility other than one run by a major chain.
DaVita operates facilities across the NEPA region, including centers in Scranton, Wilkes-Barre, Moosic, Tunkhannock, Honesdale, Mt. Pocono, and additional Pocono-area locations offering home training programs. Fresenius also operates in the area.
These are not urban medical centers with layers of oversight and competition. These are rural facilities serving communities with limited healthcare options, in a market where the patient functionally cannot walk away. You need dialysis three times a week or you die. And there may be only one provider within driving distance.
Why NEPA Is Particularly Exposed
This matters more here than it might in a major metro area, because NEPA has the conditions that produce high rates of kidney disease and the conditions that make it harder for patients to advocate for themselves.
Diabetes and hypertension are the two leading causes of kidney failure, accounting for roughly 75% of new cases nationally. According to the Pennsylvania Health Care Cost Containment Council, Pennsylvania’s statewide diabetes hospitalization rate was 24.6 per 10,000 residents for the year ending June 2025. Monroe County’s rate was 30.6, well above the state figure. Luzerne County, where DaVita also operates, came in at 26.5, also above average. The region’s population skews older, with higher rates of chronic disease and lower rates of healthcare access compared to urban counties.
One in three people with diabetes and one in five people with hypertension will develop kidney disease. As many as nine in ten adults with chronic kidney disease don’t even know they have it until it’s advanced.
This is the patient population that ends up in DaVita’s chairs. Older, sicker, more rural, less likely to have an independent nephrologist outside the dialysis center, and less likely to know what questions to ask about transplant eligibility. It’s a population that trusts its care providers because it doesn’t have other options.
What Patients and Families Should Know
Federal law requires dialysis facilities to educate patients about all treatment options, including kidney transplantation. If your center isn’t having that conversation, it’s a violation.
If you or a family member is on dialysis and you believe a transplant referral should have happened but hasn’t, there is a specific federal body that handles complaints about dialysis facilities in Pennsylvania:
ESRD Network 4 Toll-Free: (800) 548-9205 Local: (412) 325-2250 Web: qualityinsights.org
ESRD Network 4 covers all of Pennsylvania and Delaware. They investigate complaints about quality of care at dialysis and transplant facilities, including failure to refer for transplant evaluation. Complaints can be filed anonymously, and family members can file on behalf of a patient.
Additional resources include the American Kidney Fund (kidneyfund.org), the National Kidney Foundation (kidney.org), and Dialysis Patient Citizens (dpcedcenter.org), all of which provide patient rights information and Pennsylvania-specific support.
The Bigger Picture
None of what’s described here is breaking news. DaVita’s legal history is public record. The transplant referral problem is documented in peer-reviewed research. The incentive structure is understood by anyone who’s studied the industry.
But in communities like ours, where chronic disease rates are elevated, healthcare options are limited, and people trust the institutions they depend on, this information isn’t reaching the people who need it most.
DaVita may run a competent dialysis operation in NEPA. We are not alleging otherwise. What we are saying is that this company has a documented, billion-dollar history of prioritizing revenue over patients at the federal level. It operates in an industry where two companies control 80% of the market and patients cannot choose to go elsewhere. It is funded almost entirely by taxpayer money. And it operates eight facilities in a region whose population is disproportionately vulnerable to exactly the kind of neglect that history describes.
In any other industry, nearly $1 billion in fraud settlements would end a company. In dialysis, it’s a line item because the patients can’t leave, and the government keeps paying.
If you’re sitting in one of those chairs three times a week, you deserve to know that.
Know Your Rights: A Guide for Dialysis Patients and Their Families
Federal law (42 CFR § 494.70) guarantees specific rights to every dialysis patient in the United States. Your dialysis center is required to inform you of these rights when you begin treatment and to display them prominently in the facility. If you haven’t seen them, ask.
What You Are Legally Entitled To
- Be informed about ALL treatment options, including kidney transplantation, home dialysis, and peritoneal dialysis, not just in-center hemodialysis.
- Be told about the costs associated with each option, including transplant and living donor costs.
- Review your own lab values and receive a clear explanation of what they mean.
- Participate in all aspects of your care plan.
- Refuse any treatment or withdraw consent at any time.
- Seek a second opinion from any physician.
- File a complaint without fear of retaliation.
Warning Signs Your Center May Not Be Advocating for You
- No one at your center has ever discussed transplant as an option.
- You asked about transplant and were told “you’re not a candidate” without being referred to a transplant center for a formal evaluation.
- No social worker has offered to help with transplant waitlist paperwork.
- You’ve been on dialysis for more than a year and transplant has never come up.
- Your care team discourages you from seeking a second opinion or switching facilities.
- You’ve requested your medical records or lab results and been given the runaround.
- You don’t know who your nephrologist is, or you’ve never had a one-on-one conversation with them about your long-term care plan.
Questions You Should Be Asking at Your Next Session
- “Am I eligible for a kidney transplant?”
- “Have I been referred to a transplant center for evaluation? If not, why?”
- “What is my current GFR?” (Referral to a transplant program is recommended when GFR drops below 30. Ideally, patients should be evaluated before reaching end-stage disease.)
- “Can I review my lab results today?”
- “What steps would need to happen for me to get on the transplant waitlist?”
- “Are there home dialysis options available to me?”
Where to Get Help
If you believe your dialysis facility is not meeting its obligations, or if you have concerns about the quality of your care:
ESRD Network 4 (covers all of Pennsylvania and Delaware) Toll-Free: (800) 548-9205 Local: (412) 325-2250 Web: qualityinsights.org Complaints can be filed anonymously. Family members can file on behalf of a patient.
American Kidney Fund: Patient rights, financial assistance, and advocacy kidneyfund.org/living-kidney-disease/kidney-patients-rights
National Kidney Foundation: Dialysis Patients’ Bill of Rights (PDF) kidney.org/dialysis-patients-bill-of-rights
National Kidney Foundation: How to file a facility complaint kidney.org/kidney-topics/dialysis-facility-complaints
Dialysis Patient Citizens: Pennsylvania-specific resources dpcedcenter.org/resources/state-by-state-resources/pennsylvania
Renal Support Network: Full Dialysis Patients’ Bill of Rights rsnhope.org/dialysis-patients-bill-of-rights
Medicare Dialysis Facility Compare: Look up quality ratings and performance data for any dialysis center in the country, including transplant waitlist rates medicare.gov/care-compare
Federal Regulations Governing Patient Rights (42 CFR § 494.70) law.cornell.edu/cfr/text/42/494.70
All assertions in this article are sourced from federal court records, SEC filings, CMS data, and peer-reviewed research. A full source list is available at poconoreview.com.