Aetna Sues 6 NJ Doctors For Overbilling

WOODLAND PARK, N.J. (CBSNewYork/AP) — Aetna Inc. was suing six New Jersey physicians, claiming they filed “unlawful and excessive” bills, including nearly $57,000 for a 25-minute consultation.

The lawsuits stem from hospital care where patients were referred to in-network hospitals but received care from out-of-network physicians. The doctors don’t have contracts and set their own fees.

Aetna spokeswoman Cynthia Michener told The Record newspaper the six doctors were reimbursed $8.3 million in 2009, up from $4.9 million in 2008.

The spokeswoman said you can’t charge $56,000 for a $74 ultrasound procedure.

The lawsuit alleges cardiologist Deepak Srinivasan at Hackensack University Medical Center increased his fee from $1,400 to $16,380 for the first 30 to 74 minutes of services for critically ill patients.

The doctor’s lawyer, George Frino, called Aetna’s suit “a gross abuse of the judicial system.”

(TM and Copyright 2011 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2011 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)

  • Robert Senn

    as usual the pasiant is raped

  • Rodrigo Alan

    Just because the doctor charges an excessive amount, Aetna or any insurance will only pay what their Reasonable and Customary Allowable Rate for a particular region warrants according to a worked out mathematical formula.

    I worked in medical accounts for over years 20 and can attest to this fact. The doctors can charge whatever, that doesn’t mean they are going to be paid that amount. The error lies with Aetna and not the doctors. Aetna was stupid to pay such fees. But they are entitled to recoup amounts above their standard rates.

  • Bridget

    Aetna does not pay $64.00 for an office visit in-network. I live in NJ and a negotiated rate for an RNP visit was $188.00 for a 2 minute visit in the ER. Actually her PA student in training was the one that evaluated me she came in and said there were no broken bones in my hand and sent me home with an ace bandage. Turns out my hand had a fracture that an Orthopedic doctor found right away unfortunately it was 6 weeks later. The ortho go $254.00 in network for looking at my x-ray and giving me an $10 hand brace. Most of my doctors in network get a minimum of $100 for an office visit

  • b

    i do critical care billing in the midwest and there is no way in hell that the fees are what these md’s billed! Get real guys, did you think you would not be caught?

  • b

    what about when the insurance pays 1,200 for a 29,000 operation or 64 for a 200 office visit because of usual and customary. I know why they do it. Not right but the insurance companies are crooks

    • Joyce

      And the doctors are saints…yeah, right

  • nycnative

    Gross abuse of the judicial system??? Please, this is why premiums go up every year.

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