Aetna charges radiology group with fraud, abuse of federal arbitration

Aetna, the health insurance giant owned by CVS Health, is suing one of the country’s largest networks of radiology practices, alleging a scheme in which radiologists in Florida jacked up prices and abused the new federal process that settles out-of-network medical claims.

The lawsuit doesn’t just highlight the billing games that occur behind the scenes within America’s health care system. It also is one of the most detailed to date showing how the federal arbitration system, created by the No Surprises Act in 2022, has resulted in administrative hassles, legal bickering, and big paydays for providers and attorneys — all of which are ultimately funded by consumers.

Aetna is accusing Radiology Partners of wide-ranging fraud in which its radiologists inappropriately piggybacked off an important practice’s “lucrative” contract to bill for tens of millions of dollars they should have never received. And then after Aetna terminated that practice’s contract, Radiology Partners illegally flooded the arbitration process with thousands of out-of-network claims that should have been billed under other existing in-network contracts, the lawsuit alleges.