A federal judge in the U.S. District Court for the Middle District of Florida has dismissed an Aetna lawsuit that alleged that radiology practices routed claims to secure higher reimbursement rates.
Aetna claimed Radiology Partners and Mori, Bean and Brooks used a strategy that included submitting tens of thousands of disputes through the No Surprises Act’s independent dispute resolution process and obtaining millions in awards, according to court documents filed April 16 that were reviewed by Becker’s.
The insurer also argued some claims were misrepresented as out-of-network services. In one example cited in the complaint, a $78.89 in-network service resulted in a $752 payment after arbitration.
The court found Aetna the claims could not overcome limits on challenging arbitration decisions under the Federal Arbitration Act. The judge said Aetna had prior knowledge of the billing practices and did not raise the issue during arbitration.
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