Aetna wins $41.4M suit against Texas hospital over billing scheme

A federal judge ruled Aetna may collect up to $41.4 million in restitution from Humble (Texas) Surgical Hospital, concluding the five-bed hospital violated federal anti-kickback laws, according to Bloomberg BNA.

In an opinion issued Jan. 4, Judge Lynn Hughes of the U.S. District Court for the Southern District of Texas found HSH operated a "dishonest" billing scheme designed to "trick" the plaintiff Aetna into paying artificially inflated claims.

Specifically, Mr. Hughes found HSH created a series of shell companies through which more than 100 physicians received 30 percent kickbacks for referring patients to HSH. The hospital billed patients at in-network rates and submitted inflated reimbursement requests to Aetna, Mr. Hughes said.

The ruling comes seven months after HSH won $13.6 million in similar litigation against Cigna. In that suit, Cigna sued HSH over $5 million in alleged overpayments it made to the hospital for medical claims Cigna argued were "excessively large." The judge ruled against Cigna in June 2016 and ordered the insurer reimburse HSH $13.6 million in unpaid claims.

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