Aetna, newborn physician firms embroiled in legal battle over payments

Morgan Haefner - Print  | 

Health insurer Aetna and Pediatrix Medical Services, a Sunrise, Fla.-based provider of pediatric services, are caught up in a legal battle over each other's billing practices.

On April 20, Pediatrix Medical Services accused Aetna of manipulating medical providers into submitting lower payments, according to Law360. The suit, which claims millions in damages and was filed in Texas state court and Florida federal court, claimed Aetna's tactics were systematic.

Specifically, Pediatrix physicians in both states, and with the firm's billing entity Magella Medical Associates Billing, accused Aetna of using "sheer size and enormous market power" to threaten physicians with lawsuits.

On April 25, Aetna answered Pediatrix by naming the company in a lawsuit accusing its affiliate medical group in Sunrise, Mednax, of inflating reimbursement rates, according to a separate Law360 report. Aetna alleged Mednax and Pediatrix, which both specialize in infant care, exaggerated the severity of newborns' clinical conditions and ordered unnecessary tests, ultimately overbilling the insurer $50 million.

Aetna's lawsuit, filed in the Pennsylvania Court of Common Pleas in Philadelphia, also claimed revelations from former Mednax employees, and that statistical analysis showed the provider incentivized physicians to upcode services.

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