Court Dismissed Aetna “$99,750 Ear Wax Fraud” Lawsuit Against Hospital and Doctors

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On 04-13-2012, Court Dismissed Aetna’s Landmark “$99,750 Ear Wax Fraud” Lawsuit against An Out of Network (OON) Hospital and Two Surgeons in Hospital’s Patient Discount Practice. ERISAclaim.com Offers Webinars To Examine Its Impact On The Patient’s Rights To Choose And Patient Discount Litigation Explosions By Payers.

Is it legal for hospitals and doctors to offer indigent discount to non-Medicare patients? Even it is perfectly legal to do so for all Medicare patients.

On 04-13-2012, a Texas Court dismissed Aetna’s landmark “$99,750 Ear Wax Fraud” case against an out of network (OON) hospital and two surgeons, alleging that the hospital charged $99,750 for an ear wax removal and seeking temporary injunction to stop the hospital’s patient discount practice without collecting full deductible and co-insurance from all patients. The Court dismissed the entire Aetna lawsuit after Aetna voluntarily filed a Notice of “Plaintiff’s non-suit without prejudice” as a result of the dramatic court proceedings for the defendant hospital and two surgeons. New Webinars were announced to examine this breaking development.

According to the Court document filed on 04-13-2012, Aetna “announced to the Court that they no longer wish to pursue any of the claims asserted by them against Defendants Ifeolumipo O. Sofola, M.D., Navin Subramanian, M.D. and Humble Surgical Hospital, LLC. This non-suit terminates the case upon filing”.

The Court Case info: AETNA HEALTH INC vs. SOFOLA, IFEOLUMIPO O (MD) (Case #: 2011-73949 / Court 152)

ERISAclaim.com offers webinars to examine its impact of this 2012 healthcare landmark case on the patient’s rights to choose and payers’ litigation explosions nationwide over the provider’s patient discount practice, because more than 77% of the insured Americans in private sectors have paid for the rights to receive care from the out of network hospitals and providers, and “Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance”.
(http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm)

“This Court decision, along with all other pending Aetna cases across the nation, is very important for the 77% of the insured Americans in the private sectors with out-of-network coverage. Is it legal for hospitals and doctors to offer indigent discount to non-Medicare patients? Even it is perfectly legal to do so for all Medicare patients.” says Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance. (http://archive.hhs.gov/news/press/2004pres/20040219.html)

On Dec 7, 2011, Aetna filed this lawsuit in the District Court, Harris County, Texas. Aetna lawsuit seeks for temporary injunction to stop the hospital’s patient discount practice and PPO surgeon’s OON referrals, alleging breach of contract, conspiracy to overcharge, tortious interference, and common law fraud, including "a bill for $99,750 for the removal of ear wax”.

On Feb. 02, 2012, Aetna filed a “$66,100 bunion surgery” lawsuit in California against seven California surgery centers, seeking to stop the alleged UCR billing without collecting full deductible and co-insurance from all patients. The court case info: Aetna Life Insurance Co. v. Bay Area Surgical Management LLC, File 02/02/2012, Case #: 112CV217943, The Superior Court of California, County of Santa Clara.

According to the Crain's New York Business on Feb. 07, 2012, Aetna also quietly filed similar lawsuits last year in the State of New Jersey and New York against several out-of-network doctors for allegedly aggressive collections from out of network patients.(http://www.crainsnewyork.com/article/20120207/HEALTH_CARE/120209916)

On March 7, 2012, NY State Governor Andrew M. Cuomo announced that the Department of Financial Services (DFS) is investigating unexpected out-of-network medical costs affecting New Yorkers across the state, many of whom cannot afford to pay out-of-pocket expenses. In addition, DFS released a report finding that insurance companies are the first one to be responsible, and the healthcare providers are also responsible for unexpected out-of-pocket expenses driving so many patients into bankruptcy. The report finds an overwhelming need for increased transparency from insurers and medical service providers, and improved consumer protection measures to ensure that New Yorkers stop receiving unexpected bills. (http://www.dfs.ny.gov/about/press/pr1203071.htm)

According to the Press release on 03/07/2012 from NY State Governor Andrew M. Cuomo:

“Insurers are paying less of the cost of out-of-network care: The investigation found that insurers are moving to a system that greatly increases how much it costs consumers when they are treated out-of-network. To determine what they would pay for out-of-network care, most insurers used to use what is known as the usual and customary rate (UCR), which is supposed to be an average of actual bills for a procedure in that region. But now most are using the Medicare rate, which decreases how much insurers pay by as much as half or more in some cases. Insurers make this change hard for consumers to understand, because some are told they are going from 80% of the usual and customary rate to 140% of Medicare, which sounds like an improvement, but is not.”

The ERISAclaim.com Webinars will cover Aetna’s legal logics of fraud allegations, and compliant patient discount practice as well as proper out of network referrals only as the patient informed choice, in order to avoid being accused of any healthcare fraud, and to ensure that all patients are protected from any unexpected bills.

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm

Located in a Chicago suburb in Illinois, for over 12 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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