Aetna charges radiology group with fraud, abuse of federal arbitration

Aetna, the medical insurance big owned by CVS Well being, is suing one of many nation’s largest networks of radiology practices, alleging a scheme wherein radiologists in Florida jacked up costs and abused the brand new federal course of that settles out-of-network medical claims.

The lawsuit doesn’t simply spotlight the billing video games that happen behind the scenes inside America’s well being care system. It additionally is among the most detailed thus far exhibiting how the federal arbitration system, created by the No Surprises Act in 2022, has resulted in administrative hassles, authorized bickering, and large paydays for suppliers and attorneys — all of that are finally funded by customers.

Aetna is accusing Radiology Companions of wide-ranging fraud wherein its radiologists inappropriately piggybacked off an necessary observe’s “profitable” contract to invoice for tens of thousands and thousands of {dollars} they need to have by no means obtained. After which after Aetna terminated that observe’s contract, Radiology Companions illegally flooded the arbitration course of with hundreds of out-of-network claims that ought to have been billed beneath different current in-network contracts, the lawsuit alleges.