Radiology Partners fires back in battle with Aetna, accusing payer of ‘shamelessly prioritizing profits’

Radiology Partners is firing back in its legal battle with CVS-owned health insurer Aetna, accusing the payer of “shamelessly prioritizing profits.”

The country’s largest radiology practice filed its response in Florida Middle District Court late Wednesday. El Segundo, California-based Rad Partners believes the payer is using the court system to “pressure physicians with false and defamatory claims.” Its response comes after Aetna sued RP Dec. 23, claiming the practice executed a “multiphase healthcare fraud scheme” to bilk the insurer out of “tens of millions.” 

Rad Partners on Feb. 25 filed both a motion to dismiss these claims and a separate document seeking to compel arbitration in their dispute.  

“Our court filings make it clear that Aetna is using litigation to try to shape public perception while shamelessly prioritizing profits over patient care,” Rich Whitney, MBA, chairman and CEO of Rad Partners, said in a statement shared Wednesday morning. “Aetna’s strategy includes terminating physician contracts, exploiting the system and avoiding payments—even when those payments are binding and ordered by a neutral, federally approved arbiter. These tactics harm patients, contribute to the national physician shortage and waste healthcare resources, including driving up costs for Aetna’s own self-funded employer plans. We vehemently refute all their manufactured allegations, and we will vigorously defend our position.”

Aetna declined comment Wednesday, referring Radiology Business to the original lawsuit. In its complaint, the Hartford, Connecticut-based payer had noted that RP has acquired or affiliated with at least nine practices in the Sunshine State since RP’s founding in 2012. The radiology group allegedly identified affiliate practice Mori, Bean and Brooks as having one of the highest in-network commercial payer contracts 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 more lucrative contract amount to pad profits in the state.  

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. 

On Wednesday, RP noted that this was a “decades long” contract with MBB, a “leading” physician group in Florida. Aetna “unilaterally” pushed the practice out of network in 2022, forcing MBB to settle disputes through the No Surprises Act. Government-approved, neutral arbitrators have ruled in Rad Partner and its affiliates’ favor 98% of the time against Aetna, RP noted. The insurer, and not physicians, is the one controlling this high volume of disputes, it contends, by “underpaying thousands of claims.” 

Rad Partners believes the health insurer is now using the federal courts as a cudgel to avoid paying under these losing NSA dispute amounts. RP labeled the tactic as an “embarrassing attempt to exert undue pressure on MBB, rather than complete its existing payment obligations.” 

“As a practicing radiologist in Florida, I believe Aetna’s approach undermines doctors, making it increasingly difficult to provide essential imaging and diagnostic services,” Krishna Nallamshetty, MD, Radiology Partners’ chief medical officer, said in the same announcement. “In my opinion, Aetna’s unilateral decisions are disappointing and significantly disrupt our ability to serve healthcare facilities and patients,” he added later. “By leveraging its enormous size and outsized market power, Aetna can and does pressure physicians and hospitals, threatening access to physician-led care. 

The complaint mirrors similar allegations leveled by UnitedHealthcare’s Texas affiliate in 2023. At the time, the country’s largest commercial insurer charged that RP had executed a “pass through billing scheme” using the more lucrative contract held by its Singleton Associates affiliate in Houston. RP would purportedly use radiologists from across its vast enterprise of over 3,000 physicians to bill using the Singleton Associates contract. The California court dispute has remained dormant for more than a year, while a longer-running and related Texas reimbursement disagreement ended in August with arbitrators vacating a $134 million judgment previously awarded to Rad Partners. Aetna is represented by the same attorneys at Robins Kaplan LLP who repped UHC in the 2023 dispute.