Illinois Chiropractic Society Joins Class Action Lawsuit Against Aetna for Post Payment Audit Practices
Springfield, IL (July 20, 2010) – The Illinois Chiropractic Society (ICS), the largest chiropractic association in Illinois, today announced that it has joined with three other chiropractic associations and several individual plaintiffs in filing a lawsuit against Aetna seeking nationwide relief on behalf of chiropractors and other healthcare professionals.
The law firm of Buttaci & Leardi, LLC, in concert with the class action law firm of Pomerantz Haudek Grossman & Gross LLP, represents the ICS in the lawsuit, which challenges Aetna’s improper recoupment demands on chiropractic physicians and other healthcare providers. The action alleges that Aetna’s post-payment audit process violates the Employee Retirement Income Security Act of 1974 (ERISA), and further alleges that Aetna’s post-payment audit process and its pre-payment claim review process violate the Racketeer Influenced and Corrupt Organizations Act (RICO). The action also attacks Aetna’s clinical policy bulletins that are used to deny services retroactively.
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Class Action Suit has been Filed
The suit has been filed as a class action on behalf of all healthcare providers nationwide who have been harmed by Aetna’sconduct. The ICS has joined the action in a representational capacity on behalf of its members.
“Retroactive reviews, post-payment audits, and recoupment demands are becoming far too common in the insurance and healthcare arena. Many of our members and other healthcare providers around the country are harmed by these practices,” said Marc Abla, CAE, Executive Director of the ICS. “It is unjust for both the provider and patient when the insurance company demands return of payment for past claims, sometimes years after the service was performed and payment rendered.”
In addition to challenging Aetna’s recoupment effort, the lawsuit challenges Aetna’s justifications of its repayment demands. The ICS finds that a substantial portion of Aetna’s justifications relate to chiropractic services that Aetna deemed after the fact to be experimental and investigational and, therefore, not covered services under the applicable health care plans.
The Complaint seeks:
- to stop Aetna from continuing to engage in impermissible audit and recovery practices;
- to stop Aetna from enforcing clinical policies that are substantively baseless;
- compensation for chiropractors who have been coerced into making payments to resolve or defend against Aetna’s unlawful overpayment actions; and
- to order Aetna to find that certain chiropractic services are covered under the plans Aetna offers, underwrites or administers.
Counsel for plaintiffs are continuing to investigate these claims and other related claims that may be added to the litigation.
If you have any questions, please contact Marc Abla, CAE, Executive Director for the Illinois Chiropractic Society by emailing marc@ilchiro.org/ or by calling (217) 525-1200.
