Source: Pomerantz Haudek Block Grossman & Gross LLP

Pomerantz Files Class Action Suit Against Aetna On Behalf of Healthcare Providers to Challenge Abusive Post-Payment Audit Practices

NEWARK, N.J., July 29, 2009 (GLOBE NEWSWIRE) -- Pomerantz Haudek Grossman & Gross LLP today announced that it and co-counsel Buttaci & Leardi, LLC, have filed a class action lawsuit against Aetna, Inc., and its various health insurance subsidiaries on behalf of a putative nationwide class of health care providers, the Association of New Jersey Chiropractors ("ANJC") and the New York Chiropractic Council ("NYCC"). The suit challenges Aetna's abusive practices in using post-payment audits, with false allegations of fraud, to pressure providers to repay substantial sums that have previously properly been paid for providing services to Aetna subscribers.

The action alleges that Aetna's post-payment audit process violates the Employee Retirement Income Security Act of 1974 ("ERISA"), in that its repayment demands are retroactive determinations that particular services are not covered under the terms of Aetna's health care plans, but without any of the appeal or other protections otherwise available under ERISA for both self-funded and fully insured health care plans offered through private employers. The complaint further alleges that both the post-payment audit process and the pre-payment claim review process employed by Aetna to strong-arm chiropractors into unfavorable settlements violate the Racketeer Influenced and Corrupt Organizations Act ("RICO"). In addition to challenging the process by which Aetna pursues and applies its audits, the complaint also challenges numerous clinical policy bulletins of Aetna, which are used to deny services retroactively without adequate basis or clinical support.

The ANJC and the NYCC are participating in the action in an associational capacity on behalf of their members. Four chiropractors, Donna Restivo, D.C. and Christopher Foglia, D.C., of New York, Todd Carnucci, D.C., of New Jersey, and Peter Manz, D.C., of Ohio, as well as one surgeon, Leon Egozi, M.D., of Florida, have sued as the class representatives of the putative class. "These plaintiffs, all of whom have been egregiously harmed by Aetna's improper practices, are standing up to represent the interests of their profession," says D. Brian Hufford of Pomerantz Haudek. "We are seeking to add fairness into the process, while protecting providers whom Aetna is attacking for simply doing their jobs in providing medically necessary health care services to their patients."

In the complaint, plaintiffs allege that, as a means to maximize its profits, Aetna is using its post-payment audit process to pressure providers by claiming that they have been overpaid in the past for services that are not deemed to be covered under its health care policies, including because they purportedly are experimental and investigational. "Not only are Aetna's policies invalid and contrary to acceptable medical procedures," says Vincent N. Buttaci, of Buttaci & Leardi, "but in making its demands Aetna fails to provide even minimal due process, which is required under ERISA before Aetna can make an adverse benefit determination." The complaint further alleges that, in making its recoupment demands, Aetna uses "statistical extrapolations" from its purported review of just a handful of claims, thereby issuing retrospective denials of numerous other non-reviewed services. In doing so, Aetna violates -- and continues to violate -- the legal rights of providers, and the patients they treat.

Based on the allegations in the Complaint, Plaintiffs seek: (1) to enjoin Aetna from continuing to engage in impermissible audit and recovery practices; (2) to stop Aetna from enforcing clinical policies that are substantively baseless; and (3) compensation for Providers who have been coerced into making payments to resolve or defend against Aetna's unlawful overpayment actions, or who otherwise have been denied reimbursement for validly provided healthcare services.

Pomerantz Haudek, which has offices in New York, Chicago, Washington, D.C., Columbus, Ohio and the San Francisco Bay area, is acknowledged as one of the premier plaintiff class action firms, and, in particular, has been a leader in the industry in health care class actions on behalf of providers and patients. Founded by the late Abraham L. Pomerantz, known as the dean of the class action bar, Pomerantz Haudek pioneered the field of securities class actions. Today, more than 70 years later, Pomerantz Haudek continues in the tradition he established, fighting for the rights of the victims of fraud, breaches of fiduciary duty, and corporate misconduct. The Firm has recovered numerous multimillion-dollar damages awards on behalf of class members.

Buttaci & Leardi, based in Princeton, New Jersey, has a dynamic national health care practice, representing licensed health care providers, group practices and other provider-related entities throughout the country. It has extensive experience representing providers in challenging post-payment audits, including those pursued by Aetna, and has obtained tremendous success on behalf of its clients.

Counsel for plaintiffs are continuing to investigate these claims, and other related claims that may be added to the litigation. If you have any questions, please contact D. Brian Hufford, Esq. of Pomerantz Haudek Grossman & Gross LLP, by phone (614-410-6501) or email (dbhufford@pomlaw.com), or Vincent N. Buttaci, Esq., of Buttaci & Leardi, LLC, by phone (609-919-6312) or email (vnbuttaci@buttacilaw.com).

CONTACT: Pomerantz Haudek Grossman & Gross LLP

         Teresa Webb

         (888) 476.6529

         (888) 4.POMLAW

         tlwebb@pomlaw.com

Keywords: CLASS ACTION LAWSUITS