April, 2015 | The Law Offices of Gregory D. Jordan

In federal case, insurance company sues Texas hospital for tortious interference

In late February, Aetna Life Insurance Company filed a lawsuit against North Cypress Medical Center, claiming tortious interference.

Aetna claims that North Cypress designed an out-of-network strategy that charged unnecessarily high fees to Aetna, and that it improperly offered ownership interests in the hospital in exchange for patient referrals.

The lawsuit argues that the action by North Cypress constitutes tortious interference (intentional, damaging interference in a business relationship) with in-network agreements between Aetna and the hospital’s physician-owners. The company further argues that the hospital’s actions violate the federal Racketeer Influenced and Corrupt Organizations Act (RICO) and the Participating Facility Agreement between the hospital and MultiPlan, Inc., an affiliate of Aetna.

According to the lawsuit, North Cypress has also violated Texas statutes regarding unapproved billing practices, unprofessional conduct and inappropriate payment for referrals.

Allegedly, North Cypress’ out-of-network strategy included charging grossly excessive fees, providing illegal kickbacks to doctors for referrals, waiving the financial responsibility of Aetna members, upcoding and improperly using non-specific billing codes, and simply overcharging. According to the suit, these practices resulted in Aetna being overcharged by up to $120 million.

The lawsuit was filed in U.S. District Court for the Southern District of Texas, Houston Division.

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