Aetna has filed a lawsuit against Radiology Partners and Mori, Bean and Brooks, RP's Jacksonville, Fla.-based affiliate, alleging a fraud scheme that resulted in overpayments totaling tens of millions of dollars, according to court documents obtained by Becker's.
The lawsuit, filed Dec. 23 in the U.S. District Court for the Middle District of Florida, alleges that Radiology Partners used Mori, Bean and Brooks' tax identification number for services performed by other radiology groups affiliated with Radiology Partners in Florida.
Due to the increased volume of claims submitted and subsequent evasive responses to inquiries, the lawsuit alleges, Aetna terminated its in-network contract with MBB in July 2022, rendering MBB an out-of-network provider.
Following the contract termination, Aetna claims that Radiology Partners continued to bill services through MBB, now as an out-of-network provider. The lawsuit alleges the practice exploited the No Surprises Act's independent dispute resolution process by initiating numerous arbitrations for services that should have been billed under existing in-network agreements.
"RP and MBB strongly dispute Aetna's allegations and stand by the integrity of its owned and affiliated practices, which comply with all applicable healthcare laws and regulations and ordinary business practices," Radiology Partners said in a statement. "Aetna's actions appear to reflect a broader response to its terrible track record for reimbursing medical practices under the federal No Surprises Act."
According to RP's statement, the complaint did not mention that MBB has a 98% win rate through No Surprises Act arbitration.
"This overwhelmingly clear trend indicates neutral third parties applying federal law conclude Aetna uniformly fails to fairly compensate providers who support patient care," the statement continued. "As the only available avenue when a provider is forced out of network by Aetna, MBB turned to the NSA arbitration process for relief when the payor underpaid for services MBB had rendered to its members."
Aetna contends that this scheme led to overpayments amounting to tens of millions of dollars and seeks compensatory and punitive damages, restitution of overpaid amounts and injunctive relief to prevent further fraudulent billing practices by the defendants.