Aetna Sues Radiology Partners Alleging Fraud Scheme

Aetna Sues Radiology Partners Alleging Fraud Scheme - Healthcare Law Update - February 2025 - Brach Eichler
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2/7/2025

In December 2024, Aetna filed a lawsuit against Radiology Partners (RP), the country’s largest radiology and imaging practice, alleging that RP executed a “multiphase healthcare fraud scheme” in Florida which defrauded Aetna out of tens of millions of Dollars. RP is a private equity backed radiology practice that is structured in a manner in which each RP-owned practice retains its own identity despite being functionally owned by RP. Within this structure, each group maintains its own taxpayer identification number and payor contracts while RP maintains operational control and keeps a share of the profits of each group.

In its lawsuit, Aetna alleges that RP identified that MBB Radiology (MBB), an RP affiliated radiology practice, had lucrative in-network contracts with certain payors, including Aetna, and began using MBB’s name and taxpayer identification number to submit bills for radiology services provided by all of RP’s affiliated Florida radiology groups, notwithstanding that each group had their own provider agreement with Aetna. According to Aetna, RP’s use of MBB’s tax identification number to bill for services performed by other RP affiliated radiology groups misrepresented that MBB, as opposed to the other RP affiliated groups, performed those services and resulted in Aetna paying RP significantly more than what RP was entitled to be paid if all of the services had been billed properly by RP.

Eventually, Aetna terminated MBB’s in-network contract, making MBB an out of network radiology provider subject to the No Suprises Act (NSA), while the other RP affiliated groups in Florida remained in-network with Aetna. Thereafter, Aetna alleges that rather than billing through the appropriate RP affiliated radiology groups with existing Aetna contracts, RP continued to fraudulently bill for radiology services provided by all of its Florida groups through MBB, resulting in a large number of arbitrations under the NSA, many of which related to services that were performed by RP affiliated groups that were in-network and thus ineligible for arbitration under the NSA, and resulting in Aetna paying significantly more to RP than what RP was actually owed for those services.

Click Here to read the entire February 2024 Healthcare Law Update now!

For more information, contact:
Joseph M. Gorrell | 973.403.3112 | jgorrell@bracheichler.com
Richard B. Robins | 973.447.9663 | rrobins@bracheichler.com
Paul DeMartino, Jr. | 973.364.5228 | pdemartino@bracheichler.com

*This is intended to provide general information, not legal advice. Please contact the authors if you need specific advice.

Related Practices:   Healthcare Law

Related Industry:   Healthcare