According to court records recently obtained by Terre Haute Vice News, local doctors with Internal Medicine Nephrology (IMN), including Dr Manish Gera, settled a $2 million dollar lawsuit with Fresenius Medical Care.

The lawsuit was filed by IMN alleging that Fresenius was, “engaging in unlawful attempts to … monopolize the market for kidney dialysis in Terre Haute.”

In response, Fresenius filed a counter claim alleging that the lawsuit filed by IMN was retaliation in response to the decision of Fresenius to, “not renew the parties’ (IMN) medical director relationship for certain Fresenius facilities.”

The context of the suits revolve around the relationship between dialysis treatment facilities and the medical directors that are required by law to oversee their operations.

Whenever an individual medically requires dialysis treatment, those treatments are covered by Medicare, and the operation of dialysis treatment facilities around the country must adhere to their guidelines.

Starting in 2006 Fresenius purchased several existing dialysis treatment facilities in and around Terre Haute and entered into agreements with IMN to serve as the medical directors of those facilities.

That left Fresenius and IMN as the only option for outpatient dialysis treatment in the area. Then, in 2017 Davita began opening clinics in counties surrounding Vigo. IMN’s lawsuit alleges that Fresenius pressured the group to stop referring patients to Davita clinics.

In January of this year, Dr Andre Obua drove 18 hours from Miami, Florida to the home of Dr Manish Gera in Terre Haute, and shot Dr Gera in his driveway. Gera survived and Obua was arrested for attempted murder.

In conversations THVN had with Obua, and in letters sent by Obua to CBS news, he revealed that he was angered by the corruption in the dialysis treatment industry, and had chosen Dr Gera as a target based on research he had done into that corruption.

Currently the companies Davita and Fresenius dominate the field of dialysis treatment, controlling nearly 80% of the market. According to financial reports the companies generated over $30 billion dollars in revenue in 2024.

Both companies are also currently the defendants in a lawsuit filed by the United Food and Commercial Workers Local 1776 alleging that the companies have artificially inflated the price of dialysis treatment by agreeing not to compete in certain areas of the country.