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Chiropractors sue for relief from insurer’s audits

//July 30, 2009

Chiropractors sue for relief from insurer’s audits

//July 30, 2009

Suit claims Aetna’s post-payment audit process violates the Employee Retirement Income Security Act of 1974.The Association of New Jersey Chiropractors, in Branchburg, said Thursday it filed a class-action suit against insurer Aetna Inc., alleging the insurer imposed improper recoupment demands. The suit was filed on behalf of health care providers across the country.

A representative for Aetna in Hartford, Conn., said the company cannot discuss pending litigation but, in general, the company “takes seriously” its obligations to identify health care fraud and seek payment from those who abuse the health care payment system.

The Association of New Jersey Chiropractors represents 1,500 members across the state.

The suit claims Aetna’s post-payment audit process violates the Employee Retirement Income Security Act of 1974. The suit also claims the insurer’s post-payment audit process and its prepayment claim review process violates the Racketeer Influenced and Corrupt Organizations Act.

The suit also claimed the insurer’s clinical policy bulletins were used to retroactively deny of services.

The complaint alleges Aetna has actively sought repayment for a variety of treatments deemed by the insurer to be experimental and investigational, and not covered after the care had been provided. Such treatments named in the complaint include aqua massage, electrical stimulation and chiropractic biophysics.

The suit seeks changes to Aetna’s practices, as well as compensation for chiropractors that made such repayments to the insurer.

E-mail Joao-Pierre Ruth at [email protected]

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