Aetna wins $8.4M judgment in ER scam

A Texas federal judge awarded Aetna $8.4 million last week in its lawsuit against healthcare providers for posing as emergency rooms to overcharge for services, Law360 reported. Aetna will take funds from Cleveland Imaging and Surgical Hospital LLC, Trinity Healthcare Network, ER DOC 24/7 PLLC and Premier Emergency Room and Imaging. The hospital sold the right to use its billing codes to free-standing clinics in return for a 15 percent share of the clinic billings. Then the clinics filed for hospital rather than clinic services to generate higher payments. "Freestanding ERs trying to circumvent the law and collect facility fees without a state license or any real affiliation with hospitals is outrageous and unacceptable," Aetna spokeswoman Anjie Coplin told Law360. Article

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.