A New Jersey district judge ruled June 21 that Aetna's recoupment of payments made to Lutz Surgical Partners were in violation of the Employee Retirement Income Security Act.
The initial lawsuit from 2014 alleges that Aetna's recovery policies yielded plaintiffs without plan benefits they were entitled to because they were diverted to cover an overpayment from another plan.
The court ruled that these actions and others amounted to cross-plan offsetting practices, trumping Aetna's claims that their actions were permitted under state law.
The court also ruled in favor of the plaintiffs' call for a pro rata calculation to determine benefits due, which the judge allowed due to Aetna's holding of benefits in a pooled bank account.
As of the date of the issued opinion, Aetna has 21 days to amend its counterclaim on the matter.