A new twist has emerged in the legal saga involving health insurance giant Aetna and national medical group Mednax.
In a motion filed on March 1, Hartford, Connecticut-based Aetna accused Mednax of destroying evidence pertaining to an overbilling lawsuit the insurer filed in 2018. Sunrise, Florida-based Mednax denied the allegations but requested time until the end of the month to respond.
Here are five things to know about the suit and new accusations:
1. The overbilling lawsuit
About three years ago, Aetna filed a lawsuit against Mednax alleging the medical group had been “upcoding” claims since at least 2009. This means, Mednax routinely listed codes that exaggerated the care needed and performed, allowing the group to submit inflated bills to Aetna for higher reimbursement.
Aetna said it analyzed “tens of thousands of claims,” and concluded that claims from Mednax exceeded those of other physician groups by more than 18%.
2. Mednax’s motion for dismissal
Mednax moved to have the lawsuit dismissed on several grounds. Mednax said that the statute of limitations had passed on Aetna’s claims and that the insurer “failed to adequately set out the facts of the alleged fraud.”
Further, Mednax said the payer’s allegations were insufficient because they did not provide a “representative sample” of any particular claim that they allege Mednax upcoded.
But a federal judge denied Mednax’s motion for dismissal, allowing the lawsuit to move forward.
3. Aetna’s accusations of evidence tampering
Aetna filed a motion last week alleging that Mednax “automatically and permanently deleted what likely amounts to hundreds of thousands of email records.”
According to Aetna, Mednax failed to install a “single litigation hold” between January 2015 and June 22, 2018, during which time the medical group’s email auto-deletion function “chewed through and destroyed” thousands of emails.
Mednax waited until December 2019 to tell the insurer about its email destruction policy, Aetna claimed.
The payer has asked the U.S. District Court for the Eastern District of Pennsylvania to impose sanctions upon Mednax for these actions and to hold an evidentiary hearing on the issue.
4. Mednax’s response
Mednax has requested a 14-day extension of the deadline — from March 15 until and including March 29 — to respond to the accusations.
The medical group asked for this extension based on the following considerations: the size and length of Aetna’s submission which spans 30 pages, the fact that the parties are in the process of scheduling nearly 20 depositions between now and April 13, and that granting the extension will not upset the litigation schedule.
The court has granted the extension.
5. What the companies are saying
Aetna declined a request for comment from MedCity News, stating that the company does not comment on pending litigation.
Mednax provided the following comment via email: “Mednax disputes the charges leveled in Aetna’s motion and will soon be filing its response. The company has not destroyed or otherwise spoliated evidence in this case, which is itself without basis.”
Photo: Mykola Velychko, Getty Images
