CVS-owned healthcare insurer Aetna has filed a lawsuit in the U.S. District Court for the Middle District of Florida against Radiology Partners, Inc. and its affiliate, Mori, Bean & Brooks (MBB).

The lawsuit accuses the companies of orchestrating a healthcare fraud scheme that allegedly cost Aetna and their plan sponsors nearly 20 million dollars, the insurer says.

The lawsuit accuses the private equity-backed radiology group Radiology Partners and MBB of abusing the federal No Surprises Act (NSA) arbitration process and engaging in fraudulent billing practices.

Under the No Surprise Act, patients are protected from surprise medical bills, and an arbitration process is in place for patients to dispute billing concerns.

The lawsuit says that the defendants not only violated this law in a fraud scheme, but they also made efforts to conceal their wrongdoing.

The purported scheme dates back to 2018 when Radiology Partners acquired MBB. After the acquisition, Radiology Partners allegedly used MBB’s Tax Identification Number (TIN) to bill Aetna for services that were provided by other radiology groups throughout the state. However, these groups had their own contracts with Aetna.

By billing through MBB, Radiology Partners was allegedly able to exploit higher reimbursement rates for the services billed.

“Through this fraud, Defendants caused Aetna and its plan sponsors to pay significantly more for the same services provided by the same physicians at the same hospitals," attorneys laid out in the complaint. “This was a purely profit-driven scheme.”

With these alleged fraudulent billing practices, Aetna paid out inflated amounts for the same services, rendering over 20 million dollars in improper payments Aetna explains.

The complaint highlights that in one instance, Aetna paid $14.50 for a routine chest X-ray that was billed by a different radiology group. However, when that same service was billed using MBB’s TIN, the cost jumped to $252.12, an increase of over 1,600%.

The lawsuit goes on to say that Radiology Partners went on to bill as an out-of-network provider after MBB’s contract with Aetna ended in 2022. This shift to out-of-network billing would further violate the No Surprises Act.

The lawsuit goes on to allege Radiology Partners were the mastermind behind the scheme yet they had the support of the private equity groups that backed them.

Radiology Partners was able to exert control over the other radiology groups because they concealed their relationships all while making it appear that they were being compliant with state regulations.

Aetna says that this widespread scheme not only impacts them but puts some more strain on patients because the fraudulent practices resulted in a significant increase in healthcare costs without improving the quality of care Floridians received.

Aetna is seeking compensatory and punitive damages. The insurer is also seeking to be reimbursed for the improper payments and are asking the court for an injunction that would stop the defendants from continuing their alleged illegal practices.

Radiology Partners shared a statement in Radiology Business where they vehemently denied the claims. Their statement read in part, “RP and MBB strongly dispute Aetna’s allegations and stand by the integrity of its owned and affiliated practices, which comply with all applicable healthcare laws and regulations and ordinary business practices.”