Aetna claims Mednax and Pediatrix falsely inflated claims

By Noddy A. Fernandez | Jun 14, 2018

HARRISBURG — Four Aetna health insurance companies are suing a group of medical facilities, citing alleged fraud and unjust enrichment.

HARRISBURG — Four Aetna health insurance companies are suing a group of medical facilities, citing alleged fraud and unjust enrichment.

Aetna Inc., Aetna Health Inc., Aetna Health Management LLC and Aetna Life Insurance Co, filed a complaint May 25 in Pennsylvania Commonwealth Court against Mednax Inc., Pediatrix Medical Group Inc. and Mednax Services Inc., alleging that the defendants falsely represented that claims for covered services were medically necessary.

According to the complaint, since 2009, the plaintiffs were victims of an alleged scheme through which the defendants overbilled them and their employer self-funded health plans by artificially and fraudulently inflating the severity of the clinical conditions of new patients. In addition, the plaintiffs claim Mednax made infant patients appear sicker than they actually were so that they could receive a higher reimbursement. 

As a result of the alleged scheme, the plaintiffs said they paid in excess of $50 million more than they should have to Mednax. 

The plaintiffs claim the defendants allegedly false representations to Aetna when submitting thousands of claims containing improperly inflated charges.

The plaintiffs request a trial by jury and seek a judgment for actual damages in excess of $50,000, exclusive of interest and costs, as well as punitive damages and other and further relief as the court may deem just. They are represented by John Elliott, Frederic Santarelli, Gregory Vosbell and Thomas Helbig Jr. of Elliott Greenleaf PC in Blue Bell, Pennsylvania.

Pennsylvania Commonwealth Court case number 2:18-cv-02217-WB

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Organizations in this Story

Aetna Health Inc. Pennsylvania Commonwealth Court

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