Aetna Says Med Group Overbilled $50M For Newborn Care

Law360 (April 26, 2018, 6:37 PM EDT) -- Health insurer Aetna Inc. has accused medical group Mednax Inc. of exploiting its higher reimbursement rates by exaggerating the severity of the clinical condition of newborns and ordering unnecessary tests, resulting in $50 million in overbilling.

In a lawsuit filed Wednesday in the Pennsylvania Court of Common Pleas in Philadelphia, Aetna alleged that statistical analysis and revelations by former Mednax employees showed that the medical group and related provider Pediatrix, which is also named in the suit, incentivized doctors to "upcode" newborns in order to take advantage of the fact that the insurer reimbursed at a higher rate for more serious...

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