Class Action Suit Filed in NJ US District Court
By A class action suit was filed July 29, 2009 in U.S. District Court, District of New Jersey by Buttaci & Leardi, LLC and the renowned class action law firm of Pomerantz Haudek Grossman & Gross LLP. These firms have been retained by the Association of New Jersey Chiropractors (ANJC) on behalf of it’s membership, chiropractors and other health care providers. The suit alleges that Aetna’s post-payment audit process is violative of the Employee Retirement Income Security Act of 1974 (‘ERISA’). It further alleges that Aetna’s post-payment audit process and its pre-payment claim review process violate the Racketeer Influenced and Corrupt Organizations Act (‘RICO’) and calls into question the retroactive application of Aetna’s clinical policy bulletins in order to deny provided services previously paid under their claims. These clinical policy bulletins are being used as the basis for demanding refunds of payments for services rendered, and previously determined as payable, as experimental and/or unproven to be clinically effective.
Further information about the suit (case # 3:09-CV-03761-JAP-TJB) can be found through the following links;
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I think the charges put on Aetna must not be right as this is one of the most prestigious organizations working in the US.
I suppose that comment might be tongue-in-cheek.
A related story…
Aetna Forcing 600,000-Plus To Lose Coverage In Effort To Raise Profits
Well, I personally do not believe that Aetna to be blamed here as if we see the track record of Aetna, it is the most systemic type of organization working in US and should not be blamed like this.
Amy and Jennifer, I respectfully disagree with you on this. First, the practice of doing post payment audits is a reality. It is happening daily to Chiropractors from companies like, and including Aetna. Amy, “prestigious” that has to be a joke. I have choice words for Aetna but prestigious is not one of them. Have you ever had to wait for payment from them? Got the 30/60/90 day run around? They are not an upstanding user friendly company. Guess I won’t be getting a Christmas card from them now?
In Washington State, it is Premara that is conducting post-payment audits.