A CBS News investigation uncovered that since 2013, dialysis centers have been cited by federal regulators for more than 115,000 deficiencies, including poor training and unsanitary conditions. A doctor is on trial in connection to the alleged shooting of a kidney specialist, raising more questions about the dialysis industry.

A CBS News investigation has found that dialysis centers in the United States have been cited for more than 115,000 deficiencies since 2013, including issues such as poor training and unsanitary conditions. The investigation also notes that the majority of these deficiencies occurred at clinics owned by two large for-profit companies, DaVita and Fresenius, which together dominate the market in many cities, often leaving patients with only one provider option.

The report brings attention to the experiences of patients who rely on dialysis, the high costs to taxpayers, and concerns about the lack of competition leading to lower quality care. The investigation was prompted in part by a violent incident in Indiana, where a doctor is on trial for the attempted murder of a kidney specialist, allegedly motivated by frustration with the dialysis industry. Both DaVita and Fresenius have stated they provide high quality care and take concerns seriously.

CBS investigation finds concerns over dialysis centers across U.S.

A shocking crime in a small city in Indiana is shedding light on a big-money part of the healthcare industry. A doctor facing trial now for the attempted murder of another doctor. Erin Moriarty has been investigating what could be behind it. She joins us now. Erin, good morning. Good morning. Tony, this caught everyone off guard. Dr. Andrea Bua is accused of shooting and wounding a local kidney specialist. CBS News has evidence that this shooting may have been a copycat of this alleged murder caught on camera in New York last December of UnitedHealthcare's CEO. The possible motive, according to our CBS News investigation, outrage over the state of a multi-billion dollar industry. That male was shot in the hand. What you're seeing here is the aftermath of the attack on a local kidney doctor. He shot me with a handgun. The alleged assailant is another doctor, Andrea Bua. According to law enforcement, there's no evidence Dr. Bua knew the victim. But in letters to CBS News, Bua is fixated on what he believes are questionable practices in an area of medicine that gets little attention, the dialysis industry. LQ, is it fair to say, you know, you're living literally day to day? Yes, literally. 35-year-old LaQuaia Goldring, or LQ, whose kidneys were damaged by childhood cancer, spends more than four hours most days hooked up to a dialysis machine. Every day, it's war. These days, she's lucky enough to get her treatment at home. But for years, she, like most patients today, relied on outpatient clinics, almost always run by for-profit companies. I can't take another day of sitting in that chair, letting somebody else stick me, going through all the physical and mental emotions that I was going through in clinic. Our CBS News investigation found that since 2013, dialysis centers have been cited by federal regulators for more than 115,000 deficiencies, including poor training and unsanitary conditions. Around 67% of those deficiencies were split between clinics reported to be owned by DaVita or Fresenius. They have a classic case of a duopoly where they control the market. Ryan McDavitt, a professor of economics at Duke, is co-author of a new study on the dialysis industry and says the lack of competition he fears is leading to poor quality care. It's a pure volume business the way it's set up right now. And in more than 2,500 cities, the choice for patients is now down to a single option. Often it's either Fresenius or DaVita. Get as many patients through as possible, giving them cookie-cutter treatment at a very low cost. With more than half a million Americans on dialysis, it's a booming business. Some patients have private insurance, but most have to rely on Medicare, costing taxpayers about $40 billion a year. We don't have competition, which means there's no discipline on these firms to deliver higher quality care at a lower cost. And then there's that strange case in Indiana. In letters and phone calls to CBS, Dr. Abua described his frustration with the dialysis industry, which he believes is profiting at the expense of patient care. Abua is facing attempted murder charges and has pleaded not guilty. Vigo County Prosecutor Terry Modessett says there's no evidence that the victim was harming patients and says there is never any justification for violence. If you've got a problem in any way with the system or anything else, we have attorney generals, we have secretary of states that you can file a complaint with, but it's never justified to take the law in your own hands. And it's important to hear from the companies. The two biggest for-profit companies, DaVita and Fresenius, declined to speak with us on camera, but in statements, both say they deliver high quality care. DaVita says it takes every concern seriously and to mischaracterize such anomalies puts patient well-being at risk. Fresenius told us that its ability to innovate for the betterment of people living with kidney disease far outpaces the industry. Well, let's talk about LG. You call her one of the lucky ones. LQ. LQ, sorry. I was thinking about the TV brand. Where does she go from here? Well, you know, really what she needs is a transplant. That is the only way off dialysis. We call her one of the lucky ones. She's still not lucky. It's a very, very tough treatment, grueling treatment. But if you have a dialysis machine at home, and this one was provided by Fresenius, you can get dialysis whenever you need it. In center, you only get it three days a week. And one thing the doctors told us is the centers are closed on Sunday. So if you go Monday, Wednesday, Friday, two days without dialysis, they say patients often die on Monday. It's a really big difference. What can you tell us about this potential copycat case? And we should point out the victim here survived. He did, which is a relief. We were stunned when we heard about this story. It's very troubling. We wrestled about how much to report something like this. He was a 29-year-old resident. But it does show how high emotions run. And he, in letters that he sent us, he wanted us to know clearly that he said that he had carried Monopoly money with him. And that was referring to the shooting. Yes, where he reportedly had carried Monopoly money. So that does seem like a real connection to those, connects to the shooting. Tried to take a life and seems to have thrown his life away. Erin Moriarty, thank you very much. Really eye-opening.

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