Christina Spicer  |  September 17, 2014

Category: Consumer News

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Aetna insurance lawsuitOn Friday, plaintiffs in the class action lawsuit accusing the insurance provider Aetna Inc. of underpayment of claims, anti-trust and racketeering filed a response to Aetna’s motion to dismiss the claims.

Lead plaintiffs, including insurance plan members, health care providers, and medical associations, initiated the class action lawsuit seven years ago. Multidistrict litigation ensued and after several years of litigation, in December 2012, the parties reached a proposed settlement agreement where Aetna agreed to pay up to $120 million for claims submitted by members of the settlement Class, including health plan members and heath care providers, in addition to the Class’ legal fees.

However, in March, Aetna reneged on the agreement, telling the court that it was terminating the settlement agreement based on the number of Class Members who opted out and also claiming that legal and factual developments since the settlement was reached led to the decision. In turn, the plaintiffs filed an amended class action lawsuit, arguing that a judge has yet to address the merits of the plaintiffs’ claims. “The proposed TAC does exactly what plaintiffs said it would do — it simplifies plaintiffs’ theory of the case, adds facts learned in discovery, and incorporates developments in the law since the case was filed years ago,” the plaintiffs’ motion for leave to file the amended complaint said. “This is all appropriate, particularly given that it comes after the case was settled and notice was sent to the Aetna class” continued the motion.

The Aetna class action lawsuit commenced in 2007, when lead plaintiff Michele Cooper filed a proposed class action in New Jersey federal court. Subsequently, in 2009, a provider Class was initiated by a group of doctors and other health care providers in 2009. Aetna is accused of violating the Employee Retirement Income Security Act, the Racketeer Influenced and Corrupt Organizations Act and the Sherman Antitrust Act, as well as state law. The plaintiffs also claim that Aetna improperly calculated out-of-network claims and did not disclose its methods.

In their filing submitted on Friday, the plaintiffs argue that they adequately stated their claims under the Sherman Act, because they demonstrated that the Class sustained an antitrust injury by paying overcharges as a direct result of an agreement among the defendants to use the third party’s database for reimbursements. The plaintiffs also argue that they demonstrated that they suffered injury because of the Aetna’s pattern of racketeering acts, and the Class Members were “the direct victims and targets of defendants’ scheme to defraud.”

The plaintiffs are represented by Carella Byrne Cecchi Olstein Brody & Agnello PC, Whatley Kallas LLP, Pomerantz LLP, Bonnett Fairbourn Friedman & Balint PC, Ridout Lyon + Ottoson LLP, Seeger Weiss LLP, Scott + Scott LLP, Kiesel Law LLP, Hoffman Libenson Saunders & Barba, and Zuckerman Spaeder LLP.

The Aetna Out-of-Pocket Provider Class Action Lawsuit is In re: Aetna UCR Litigation, Case No. 2:07-cv-03541, MDL No. 2020, in the U.S. District Court for the District of New Jersey.

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