Aetna V. BASM: A Health Care War Over Costs And Contracts

Law360, New York (April 28, 2016, 12:45 PM EDT) -- On April 13, 2016, a jury in Santa Clara, California, awarded Aetna Inc. $37.4 million from Bay Area Surgical Management LLC (BASM), six of its affiliated surgery centers and its three principals. Aetna had accused the surgery center company of a massive conspiracy to defraud Aetna and other carriers who offer out-of-network benefits by paying off doctors, lying to patients and lying to carriers and employers, the result of which was overpayment by Aetna for surgeries to the extent of tens of millions of dollars. Aetna asserted causes of action for fraud, intentional interference with contractual relations and unjust enrichment. The...

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