Just so you don’t think it’s only in behavioral healthcare….
Law360, New York (July 22, 2015, 6:55 PM ET) — Aetna Life Insurance Co. has partially settled its lawsuit alleging that two companies that operate a Pennsylvania surgery center ran a patient referral kickback scheme, according to a court order filed in Pennsylvania federal court on Tuesday.
The defendants allegedly offered doctors ownership interests in the surgery center in return for patient referrals and secretly waived millions of dollars in member responsibility payments to persuade patients to forgo using the insurer’s in-network facilities.
These and other improper business practices “unnecessarily inflated the cost of medical care to Aetna and its self-funded customers,” the complaint said.
But here’s the key language you all should pay attention to:
Aetna defended the lawsuit earlier this month, saying the defendants can’t evade liability by claiming they don’t technically qualify as health care providers.
Commentary: The defendants moved for summary judgment in the case on the basis that they aren’t health care providers covered under Pennsylvania’s anti-kickback statute. Technically, they are likely correct, but we all know you can’t beat City Hall and you can’t always beat insurance companies (though I have met some outstanding lawyers down here in South Florida who do just that), when they have the deepest pockets of them all.