A leading U.S. senator is pressing federal regulators to disclose the results of an investigation into the for‑profit dialysis industry, which critics say has become a near‑duopoly that undermines quality of lifesaving kidney care.
Sen. Richard Blumenthal, a Connecticut Democrat, told CBS News he is troubled by the “hallmarks of unlawful abuse of market power” as two companies, Fresenius and DaVita, now own nearly 75% of U.S. dialysis clinics — roughly 5,600 of about 7,600 nationwide. Blumenthal said the Federal Trade Commission had probed whether that market concentration affected patient care, but any findings have not been made public. He has asked the agency to take “appropriate robust enforcement action to remediate issues it has identified and protect patients, including veterans, from misconduct by these companies.”
About 500,000 Americans rely on dialysis to survive while waiting for kidney transplants, the only remedy for most with end‑stage kidney disease. Critics allege the dominant companies prioritize profits over individualized care. Tom Mueller, author of How to Make a Killing: Blood, Death and Dollars in American Medicine, called the care model “emergency room care done in the mall,” saying patients often do not receive tailored treatment.
Duke economist Ryan McDevitt, who has studied the sector, described it as “the most concentrated health care sector across the entire U.S.” A CBS News review of federal data found roughly one‑third of dialysis clinics — nearly 2,500 of about 7,600 — failed to meet federal standards this year, with an average score of 60 out of 100.
Both companies dispute the criticism. Fresenius highlighted that more than 65% of its centers earned three stars or higher on Medicare’s five‑star scale, saying that rate exceeds the national average and that it remains focused on improving quality and outcomes. DaVita said problems are “rare and isolated” and that its clinicians deliver high‑quality, individualized care.
Researchers point to financial incentives as a factor. McDevitt argues Medicare’s fixed reimbursements per patient push providers to maximize revenue by increasing treatment volume. In 2024, DaVita reported delivering more than 29 million dialysis treatments and earning about $391 in revenue per session; combined, DaVita and Fresenius reported $33.7 billion in revenue.
McDevitt’s research found that when independent clinics are acquired by the large chains, transplant referrals fell by about 10%, patient survival rates declined by roughly 2%, hospitalizations rose by 5%, and infection rates increased about 12% over the past two decades. Since 2013, CMS surveyors have cited U.S. dialysis centers for more than 115,000 deficiencies, including poor hand hygiene, unsanitary medication handling, and inadequate staff training.
Blumenthal also flagged the impact on veterans: some 40,000 veterans depend on dialysis while awaiting transplants. In his letter to FTC Chair Andrew Ferguson, the senator described the industry as “ripe with predatory, monopolistic potential practices” and urged an investigation and enforcement to protect patients.
Fresenius told CBS News it is cooperating with the FTC inquiry but declined further comment because the investigation is ongoing. The FTC and DaVita did not immediately respond to requests for comment.