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Aetna second big-name payer to sue Health Diagnostic Laboratory

Suit alleges fraudulent billing similar to $84M Cigna lawsuit filed in October
April 23, 2015 | By
Tools

Aetna has filed a multimillion-dollar lawsuit against Virginia-based Health Diagnostic Laboratory (HDL) Inc. The suit alleges that the firm and its former contract sales provider, Bluewave Healthcare Consultants Inc., engaged in fraudulent billing practices.

The suit, filed April 10 in the U.S. District Court for the Eastern District of Pennsylvania, seeks "tens of millions in monetary damages," but does not specify an exact amount. Cigna filed a similar $84 million "phantom rate" suit against HDL in October, FierceHealthPayer: AntiFraud previously reported.

The lawsuit alleges that HDL paid $20 blood test "processing fees" to physicians so that they would order more blood tests than necessary, according to the Richmond Times-Dispatch. As a result, Aetna said it received "inflated" medical claims.

In addition, the lawsuit alleges that HDL waived patient co-payments for its blood tests as a means of referring business to HDL, which was an out-of-network provider for Aetna customers.

Alabama-based Bluewave sold HDL's services outside of Virginia, the Times-Dispatch said. HDL terminated its contract with Bluewave this January. Both of Bluewave's founders were part-owners of HDL during the time that the fraudulent activity allegedly took place, the Pennsylvania Record reported.

HDL was founded in 2009 and reported revenues of more than $400 million just three years later, on a profit margin of 33 percent, according to Forbes. That caught the attention of the Department of Justice (DOJ), which began investigating the company in 2014.

Last month, HDL agreed to pay $47 million to settle kickback allegations similar to those raised in the Aetna and Cigna suits. The DOJ settlement does not include charges against current or former HDL executives, who could face additional fines or criminal prosecution, Forbes said.

For more:
- view the lawsuit (subscription required)
- read the Richmond Times-Dispatch article
- read the Penn Record article
- here's the Forbes article

Related Articles:
Health Diagnostics Laboratory to pay nearly $50 million to settle kickback allegations
Cigna sues lab for billing $84M in 'phantom rates'
Cardiovascular testing labs pay $48.5 million to settle kickback allegations

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