Washington is suing the state’s two biggest dialysis companies over what it claims are illegal noncompete agreements that effectively reduce treatment options for people with kidney failure.
In a complaint filed Tuesday in Thurston County Superior Court, Attorney General Nick Brown alleges DaVita and Fresenius require medical directors who oversee kidney dialysis centers to sign illegal noncompete agreements.
Under the law passed in 2019, only employees and contractors who meet certain salary thresholds can be bound to noncompete agreements. That will change starting June 30, 2027, when the law expands to ban all noncompete agreements for Washington workers.
But the state argues that DaVita's and Fresenius' agreements are void even under the current law, because the companies’ medical directors are part time and paid far below the salary threshold for independent contractors (a little over $317,000 in 2026).
The noncompete agreements prevent the companies' medical directors from taking on part-time work at a competing center in the same area. That can also mean physicians cannot provide at-home treatment within a certain geographic radius.
The agreements can apply to entire medical practices, preventing a medical director’s colleagues from working for competing dialysis centers, according to the state’s lawsuit.
“They’re doing that to corner the market and dictate to doctors where they can and can’t work, but that leaves people with fewer options for care,” Brown said in a news release Tuesday.
A spokesperson for DaVita said the lawsuit’s allegations present a “fundamentally distorted” picture of its medical director agreements.
“These are longstanding arrangements with independent physician practices, and medical directors are far more than administrators,” the spokesperson wrote in an email to The Seattle Times. “They are nephrologists whose clinical judgment, expertise and leadership are essential to quality, safety and patient care.”
Fresenius did not immediately respond to requests for comment.
DaVita and Fresenius dominate the kidney dialysis center market — both in Washington and nationwide, where they operate a combined 70% of dialysis centers, according to the lawsuit.
About 9,000 people across Washington receive dialysis treatment for kidney failure. Although treatment is possible at home with the right equipment, it usually occurs at a dialysis center three times a week for several hours at a time, according to the attorney general’s office.
DaVita and its subsidiaries operate 51 dialysis centers across Washington, while Fresenius Medical Care Holdings and its subsidiaries run 29.
State attorneys argue that the use of noncompete provisions helps the two companies maintain monopolies in certain areas. In many counties, including Clark, Lewis, Spokane and Thurston, DaVita or Fresenius are the only options for in-center dialysis treatment, attorneys said.
Washington requires state approval before a new kidney dialysis center can open, with the applicant needing to demonstrate a genuine need for the service in the community. But DaVita and Fresenius have a history of intervening in that process, arguing their competitors' medical directors were bound by noncompete agreements and unable to serve at the new facility.
“The lack of competition in this space reduces the incentive for improved quality, innovation, and access to care. The lack of competition causes concrete harm to the patient population,” the state attorneys wrote in the complaint.
This isn’t the first time DaVita’s and Fresenius’ noncompete agreements have come under fire.
In 2024, the Federal Trade Commission announced it was investigating whether the companies' noncompete agreements have resulted in a sort of market duopoly. But the FTC never filed a lawsuit or shared the results of the investigation.
In December 2025, U.S. Sen. Richard Blumenthal, D-Conn., publicly urged the FTC to release the findings of its investigation and step up enforcement against the companies. But the FTC has made no moves to do so.
“We remain in active discussions with the Federal Trade Commission regarding these arrangements and will continue to vigorously defend both their lawfulness and the critical role physicians play in caring for people with kidney failure,” the DaVita spokesperson said.
© 2026 The Seattle Times. Visit www.seattletimes.com. Distributed by Tribune Content Agency, LLC.
