Sen. Richard Blumenthal is urging federal regulators to make public the results of an investigation into the for‑profit dialysis industry, which critics say has become a near‑duopoly that may be harming care for patients with kidney failure.
Blumenthal, a Connecticut Democrat, told CBS News he sees “hallmarks of unlawful abuse of market power” as Fresenius and DaVita control roughly 75% of U.S. dialysis clinics — about 5,600 of roughly 7,600 nationwide. He has asked Federal Trade Commission Chair Andrew Ferguson to disclose what the agency has found and to take “appropriate robust enforcement action” to address any misconduct and protect patients, including some 40,000 veterans who depend on dialysis while awaiting transplants.
About 500,000 Americans rely on dialysis to survive until they receive a kidney transplant, the only option for many with end‑stage kidney disease. Critics contend the dominant chains put profits ahead of individualized care. Author Tom Mueller, who has investigated private health care practices, likened the treatment model to impersonal, assembly‑line care that can leave patients without tailored attention.
Duke economist Ryan McDevitt, who studies the sector, has called dialysis the most concentrated area of U.S. health care. A CBS News review of federal data found that nearly one‑third of dialysis clinics — close to 2,500 out of about 7,600 — failed to meet federal standards this year, with an average compliance score of 60 out of 100.
Fresenius and DaVita reject the broader criticisms. Fresenius noted that more than 65% of its centers have three stars or higher on Medicare’s five‑star scale, a rate it says exceeds the national average, and said it remains focused on improving outcomes. DaVita told CBS News that quality problems are “rare and isolated” and that its clinicians provide individualized care.
Researchers point to payment incentives as part of the problem. McDevitt argues that Medicare’s fixed per‑patient reimbursements encourage providers to boost volume to increase revenue. In 2024 DaVita reported delivering more than 29 million dialysis treatments and averaging about $391 in revenue per session; together DaVita and Fresenius reported roughly $33.7 billion in revenue.
McDevitt’s work examining acquisitions found measurable declines in some patient outcomes when independent clinics were absorbed by the large chains: transplant referrals dropped by about 10%, patient survival fell roughly 2%, hospitalizations rose by about 5%, and infection rates increased near 12% across the last two decades. Since 2013, CMS surveyors have documented more than 115,000 deficiencies at U.S. dialysis centers, citing issues such as poor hand hygiene, unsanitary medication handling and insufficient staff training.
Blumenthal specifically pressed the FTC over potential harms to veterans and other patients, describing the industry as “ripe with predatory, monopolistic potential practices” and urging enforcement to protect vulnerable people.
Fresenius said it is cooperating with the FTC inquiry but declined to comment further because the probe is ongoing. The FTC and DaVita did not immediately respond to requests for comment.