Hiding Fixed Costs On The Claim Side Of The Ledger

Posted By Rina Tikia
On Linkedin

“Evidence included correspondence showing Aetna literally told Optum to “bury” its fees by using a dummy code, and that Optum helped Aetna “scout” for a usable dummy code……”

Posted By Rina Tikia On Linkedin

The 4th U.S. Circuit Court of Appeals said Sept. 13 it will not review a lower court’s ruling that certified class-action status in a lawsuit alleging Aetna and Optum Health conspired to use “dummy code” to make administrative fees appear to be billable medical charges. The three-judge panel unanimously denied Aetna and Optum’s request to review a North Carolina federal judge’s June decision to certify class-action status, according to court records. The judges did not provide an explanation for their decision in the order.

The lawsuit, which was originally filed in 2015, alleges the two insurers tricked plaintiff Sandra Peters, other patients similarly situated and their employers into paying administrative fees by disguising them as medical expenses. The lawsuit alleges the defendants violated the Employee Retirement Income Security Act. The two classes certified by the judge could cover more than 87,000 health plan participants, according to court records.


Related Blog Posting – Weslaco ISD vs Aetna