By 2022, Aetna had already raised concerns about Mori, Bean and Brooks (MBB), alleging the practice was submitting a “significantly more” claims. The insurer believed this surge was due to Radiology Partners’ (RP) alleged “scheme.” When Aetna questioned the unusual increase, RP reportedly avoided providing clear answers, ultimately leading Aetna to terminate its contract with MBB.
According to the legal complaint, this contract termination marked the beginning of the second phase of the alleged scheme. Aetna claims that even after MBB was removed from their network, Radiology Partners continued to bill through MBB. Instead of utilizing contracts from its other Florida-based practices that remained in-network with Aetna, RP allegedly persisted with the out-of-network billing under MBB. Following this, Radiology Partners purportedly initiated “tens of thousands” of arbitration disputes against Aetna, leveraging the No Surprises Act. This federal law is designed to protect patients from unexpected out-of-network medical bills and allows out-of-network providers to seek independent arbitration to resolve payment disagreements with insurers. However, Aetna emphasizes that these other RP-affiliated groups already had in-network agreements with their health plan, making the arbitration claims questionable.
The lawsuit explicitly states, “These arbitrations were all initiated based on [Radiology Partners’] misrepresentations that they were for medical services provided by MBB.” Aetna argues that “in truth,” these claims were for services rendered by different medical groups that already had contracts with Aetna. This, according to Aetna, rendered these services ineligible for arbitration under the No Surprises Act.
Aetna further accuses Radiology Partners of providing misleading information to both arbitrators and the U.S. Department of Health and Human Services. The insurer alleges that RP was aware that Aetna lacked the necessary data to verify if the services were genuinely provided by MBB. Aetna estimates that Radiology Partners strategically filed “thousands of claims simultaneously” in batches, with the intention to “overwhelm Aetna and inhibit its ability to respond effectively.”
The complaint dramatically describes the scope of the alleged scheme as “staggering.” Aetna highlights a March 2024 report from Brookings, which noted that “Radiology Partners and three other private-equity-backed provider groups have accounted for ‘a large and disproportionate share of IDR cases’.” The report further specified, “In fact, Radiology Partners is responsible for over 90% of all IDR cases involving claims for professional radiology services,” underscoring the magnitude of Radiology Partners’ involvement in No Surprises Act arbitrations. TeamHealth and Envision Healthcare were identified in the report as the other two significant groups.
In response, Radiology Partners defends its actions, asserting that the lawsuit reflects Aetna’s “terrible track record” in fairly compensating providers under the No Surprises Act. RP points to Mori, Bean and Brooks’ 98% success rate in No Surprises Act arbitrations as evidence. According to RP, this “overwhelmingly clear trend” demonstrates that Aetna “uniformly fails to fairly compensate providers adequately.”
A Radiology Partners spokesman stated that, “rather than negotiate a contract to return to in-network status that would save its employers and members money, Aetna has been seemingly happy to pass along those costs, including the enormous fee burden of the NSA process.” The spokesman added, “We view this as an embarrassing waste of healthcare resources and would much prefer to be in network with Aetna, as we are with the vast majority of payers. We have communicated this to Aetna countless times over the last two years.”
Aetna, represented by Robins Kaplan LLP—the same law firm that previously represented UnitedHealthcare in a similar lawsuit in 2023—and CVS, Aetna’s parent company since 2018, have not yet issued further public statements. Aetna is reportedly seeking unspecified damages, potentially in the “tens of millions,” to be decided by a jury trial. The requested damages include compensatory and punitive damages, legal costs, attorney fees, and prejudgment interest.
