Aetna can't pursue any overpayments it claims it made to hospitals because of alleged fraudulent billing from Mednax, a Pennsylvania court said.
Justice Wendy Beetlestone of the U.S. District Court for the Eastern District of Pennsylvania made the decision in a memorandum opinion March 12. In the memorandum opinion, Ms. Beetlestone granted Mednax's motion to strike damages Aetna claims it is owed in hospital overpayments, which the insurer alleges were induced by the Sunrise, Fla.-based medical group's billing practices.
Aetna has argued Mednax fraudulently inflated insurance claims for services it provided in neonatal intensive care units. According to March 12 court documents, Aetna brought forth calculations from a damages expert, after fact discovery had closed, alleging damages from two sources: fraudulent billing from Mednax that led to $58.3 million in overpayments, and $102.7 million that Mednax fraudulently induced Aetna to pay hospitals with practicing Mednax physicians.
Ms. Beetlestone granted Mednax's motion to strike the second damages theory on hospital overpayments. She stated Aetna didn't properly explain why it failed to timely disclose its seeking of damages for hospital payments, adding that the insurer had maintained hospital claims weren't relevant to the case during fact discovery.
"The crux of the instant dispute lies in Aetna's representations during fact discovery that payments made to hospitals were not relevant to the case," Ms. Beetlestone said.
The memorandum opinion comes after Aetna asked the District Court for the Eastern District of Pennsylvania March 1 to sanction Mednax for allegedly destroying evidence in the case. Mednax has disputed the accusations and plans to file a response.