Aetna, the medical health insurance big owned by CVS Well being, is suing one of many nation’s largest networks of radiology practices, alleging a scheme through which 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 likely one of the most detailed so 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 shoppers.
Aetna is accusing Radiology Companions of wide-ranging fraud through which its radiologists inappropriately piggybacked off an necessary follow’s “profitable” contract to invoice for tens of hundreds of thousands of {dollars} they need to have by no means acquired. After which after Aetna terminated that follow’s contract, Radiology Companions illegally flooded the arbitration course of with 1000’s of out-of-network claims that ought to have been billed underneath different current in-network contracts, the lawsuit alleges.
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