Home > News > June, 2012
New Details Emerge in $20M Out-of-Network Lawsuit
Article highlights how 7 California surgery centers allegedly overbilled Aetna.
Published:June 5, 2012
They'd bill Aetna $73,526 for a knee arthroscopy and $66,100 for a bunion repair - and Aetna's computer system would automatically pay them 70% to 90% of the billed amount. They'd pay physician-owners to refer patients with high-paying, out-of-network insurance coverage to their 7 California surgical centers.
These and other details emerged in a scathing report by the San Jose Mercury News that outlines Aetna's $20 million out-of-network lawsuit against Bay Area Surgical Management, which we first told you about here.
Over the past 2 years, Aetna claims it paid Bay Area's 7 ASCs $23 million for 1,900 procedures, $20 million more than fair market value.
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