‘Purely profit-driven’: Aetna files lawsuit accusing Jacksonville radiology group of $20

JACKSONVILLE, Fla. – Healthcare giant Aetna has filed a lawsuit in the U.S. District Court for the Middle District of Florida accusing Radiology Partners, Inc. and its affiliate, Mori, Bean & Brooks (MBB), of orchestrating a large-scale healthcare fraud scheme that allegedly cost the company and its plan sponsors tens of millions of dollars.

The lawsuit, filed in late December, claims that Radiology Partners, a private equity-backed radiology group, and MBB engaged in a multi-phase scheme involving fraudulent billing practices and abuse of the federal No Surprises Act (NSA) arbitration process.

“Through this fraud, Defendants caused Aetna and its plan sponsors to pay significantly more for the same services provided by the same physicians at the same hospitals,” attorneys wrote in the complaint. “This was a purely profit-driven scheme.”

Fraudulent billing allegations

According to the complaint, Radiology Partners acquired MBB in 2018 and immediately began using MBB’s Tax Identification Number (TIN) to bill Aetna for services rendered by other radiology groups across Florida. These groups had their own contracts with Aetna, but billing through MBB allegedly allowed Radiology Partners to exploit higher reimbursement rates. The lawsuit claims this misrepresentation caused Aetna to pay inflated amounts for the same services, with the scheme generating over $20 million in improper payments.

The complaint details how Radiology Partners used tactics such as inflating billing charges and leveraging MBB’s contracts to maximize profits. In one instance, a routine chest X-ray billed under a different radiology group cost Aetna $14.50 but skyrocketed to $252.12 when billed under MBB’s TIN—an increase of over 1,600%.

Alleged misuse of the No Surprises Act

After MBB’s contract with Aetna was terminated in 2022, Radiology Partners allegedly shifted to out-of-network billing practices to further exploit the NSA, which protects patients from surprise medical bills and establishes an arbitration process for billing disputes. Aetna claims that Radiology Partners filed tens of thousands of arbitrations under the NSA for services that should not have been eligible, using bulk filings to overwhelm Aetna and secure inflated payments.

The complaint claims these tactics resulted in excessive arbitration awards for Radiology Partners, which were bolstered by manipulated data and misrepresented certifications.

A coordinated scheme

The lawsuit describes Radiology Partners as the mastermind behind the alleged scheme, with support from its private equity backers. The company reportedly exerted control over affiliated radiology groups while concealing these relationships to appear compliant with state regulations prohibiting corporate practices in medicine.

Aetna also accuses Radiology Partners and MBB of taking extreme measures to hide the scheme, including misleading hospitals and creating false affiliations between radiology groups.

Broader implications for healthcare costs

Aetna argues that the fraudulent practices have significantly increased healthcare costs across Florida without improving the quality of care.

The insurer claims that this scheme aligns with broader concerns about the impact of private equity in healthcare, citing a Federal Trade Commission (FTC) case against U.S. Anesthesia Partners as a comparable example of private-equity-driven consolidation and exploitation.

What’s next?

Aetna is seeking compensatory and punitive damages, the return of improper payments, and an injunction to stop Radiology Partners and MBB from continuing these practices. The company is also asking the court to vacate arbitration awards obtained through alleged fraudulent claims.

The case underscores growing tensions between healthcare providers and insurers over billing practices and the rising influence of private equity in the healthcare sector.

A high-stakes legal battle

This case marks one of the most significant legal challenges involving the No Surprises Act since its implementation. With millions of dollars and healthcare industry practices at stake, the lawsuit will be closely watched by regulators, policymakers, and industry stakeholders alike.

Radiology Partners has responded to the allegations, calling the lawsuit “unexpected.” The group strongly disputed Aetna’s allegations and stood by the integrity of its owned and affiliated practices. The statement says in part:

“This lawsuit exemplifies a conscious strategy by Aetna to leverage legal disputes rather than seek a fair resolution. Aetna does not want to negotiate, does not want to pay when it loses disputes in the NSA arbitration process. It does, however, want a judge to say it does not have to pay its bills from already-decided disputes and is seemingly content to burden employers and ultimately members through higher premiums with unnecessary and extraordinary costs of NSA arbitration.”