Judge dismisses CVS-Aetna’s lawsuit against Radiology Partners
A federal judge on Thursday dismissed CVS-Aetna’s lawsuit against Radiology Partners, which had claimed the country’s largest imaging group perpetrated a “multiphase fraud scheme.”
The Hartford, Connecticut-based healthcare corporation first filed the complaint in Florida at the end of 2024, believing Rad Partners defrauded it of “tens of millions.” Aetna’s allegations centered around the imaging group improperly funneling claims through one of its Florida practices to try and score higher reimbursements.
However, Jacksonville U.S. District Judge Brian J. Davis dismissed the complaint on April 16, granting Rad Partners’ request. As part of the lawsuit, Aetna had sought to “unwind” previous judgments the radiology group won against the insurer through the No Surprises Act’s independent dispute resolution, or IDR, process. Judge Davis denied these requests while noting that Aetna could have called out its concerns through arbitration.
Rad Partners said it was pleased with the outcome on Thursday.
“The ruling makes clear that this lawsuit could not be used to unwind IDR outcomes after the fact, particularly where those objections could have been raised through the process itself,” Malea Reising, MS, Rad Partners’ VP of strategic communications, health policy and advocacy, told Radiology Business. “More broadly, this case reflects a troubling pattern in which payers, dissatisfied with IDR results, increasingly try to attack those outcomes outside the framework Congress created rather than address the underlying payment issues driving the disputes.”
Aetna, whose health plans cover over 36 million Americans, did not immediately respond to a request for comment late Thursday. Judge Davis had dismissed the complaint “with prejudice,” meaning the insurer is barred from bringing the same claims forth again. Rad Partners said it hopes Aetna will refocus its attention with the matter now settled.
“It would be better for all parties, especially patients and their employers, if payers focused on good-faith negotiations towards sustainable, in-network contracts,” Reising added. “Radiology Partners remains committed to a fair and workable process that protects patient access and supports physicians who provide essential care.”
More on the original complaint
In the original complaint, Aetna claimed Rad Partners identified its Jacksonville-based affiliate Mori, Bean and Brooks as having one of the most lucrative in-network contracts with the payer in Florida. Rad Partners purportedly would use MBB’s name and tax ID number to bill Aetna for work performed by other rads outside of MBB, targeting the higher-paying contract amount to pad profits in the state.
Aetna estimated that Rad Partners has acquired at least nine practices in Florida since its founding in 2012, including MBB in 2018. By 2022, Aetna charged that MBB was submitting significantly more claims to the insurance company because of Rad Partners’ alleged “scheme.” When asked about this uptick, RP purportedly deflected Aetna’s inquiries, forcing the insurer to terminate its contract with the practice.
Aetna had claimed this led to Phase 2 of the alleged scheme. After knocking Mori, Bean and Brooks out of network, RP allegedly continued billing through MBB, rather than “properly” using its other Florida practices’ contracts with Aetna, which remained in-network. Rad Partners then initiated “tens of thousands” of arbitration disputes with Aetna under the No Surprises Act. The landmark legislation allows out-of-network healthcare providers to seek the expertise of independent arbitrators to settle disputes over payment. However, Aetna emphasized these other RP groups were still in-network with the health plan.
Aetna charged that, in doing so, Rad Partners provided false information to arbitrators and the U.S. Department of Health and Human Services. RP allegedly did so knowing that Aetna did not have information to identify whether the services were provided by MBB. The payer claimed Rad Partners batch-filed “thousands of claims simultaneously to overwhelm Aetna and inhibit its ability to respond.”
Rad Partners, for its part, vehemently denied the allegations last year. It noted that government-approved, neutral arbitrators had ruled in Rad Partners’ and its affiliates’ favor 98% of the time against Aetna. The insurer, not radiologists, is the one controlling the high volume of disputes by “underpaying thousands of claims.”
UnitedHealthcare, the country’s largest commercial insurer, filed a claim like Aetna’s in August, with the matter still being litigated. A federal judge also recently dismissed another No Surprises Act-related lawsuit from an Anthem affiliate, filed against HaloMD, a Texas company that helps providers navigate the IDR process.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.