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...

Stay ahead of the curve

In the legal profession, information is the key to success. You have to know what’s happening with clients, competitors, practice areas, and industries. Law360 provides the intelligence you need to remain an expert and beat the competition.


  • Access to case data within articles (numbers, filings, courts, nature of suit, and more.)
  • Access to attached documents such as briefs, petitions, complaints, decisions, motions, etc.
  • Create custom alerts for specific article and case topics and so much more!

TRY LAW360 FREE FOR SEVEN DAYS

Hello! I'm Law360's automated support bot.

How can I help you today?

For example, you can type:
  • I forgot my password
  • I took a free trial but didn't get a verification email
  • How do I sign up for a newsletter?
Beta
Ask a question!