newjerseynewsroom.com

The Association of New Jersey Chiropractors (ANJC), one of the largest chiropractic state associations in the nation, announced Thursday that it has filed a lawsuit against Aetna seeking nationwide relief on behalf of chiropractors and other healthcare professionals.

The ANJC retained the law firm of Buttaci & Leardi, LLC, in concert with the renowned class action law firm of Pomerantz Haudek Grossman & Gross LLP, to investigate and file the lawsuit, which challenges Aetna's improper recoupment demands on chiropractors and other healthcare providers.

The action alleges that Aetna's post-payment audit process is violative of the Employee Retirement Income Security Act of 1974 ("ERISA"), and further alleges that Aetna's post-payment audit process and its pre-payment claim review process violate the Racketeer Influenced and Corrupt Organizations Act ("RICO"). The action also attacks Aetna's clinical policy bulletins that are used to deny services retroactively.

"The scourge of post payment audits by health insurers has become all too familiar to chiropractors across the country," said Dr. Sigmund Miller, Executive Director of the ANJC. "Indeed, insurance carriers continue to bombard chiropractors with refund requests demanding repayment of thousands upon thousands of dollars. Aetna, in particular, has been active in auditing and thereafter seeking recoupment from chiropractors."

In addition to challenging Aetna's recoupment effort, the Complaint challenges Aetna's excuses to justify its repayment demands. ANJC finds that a substantial portion of Aetna's justifications relate to chiropractic services that Aetna deemed-after the fact-to be experimental and investigational, such that they are no longer deemed to be "covered services" under the applicable health care plans.

Among other services, Aetna claims that the following chiropractic services are no longer covered because they purportedly have not been demonstrated to be safe and effective: Surface Scanning Electromyography ("SEMG"); Intersegmental Mechanical Traction; Electrical Stimulation; Activator and other Manipulative Devices (i.e., Proadjuster); Active Release Technique; Chiropractic Biophysics ("CBP"); Sacro Occipital Technique ("SOT"); Nerve Conduction Velocity ("NCV") studies; Manipulation under Anesthesia ("MUA"); and Aqua Massage (Dry Hydrotherapy).

The action alleges that many of these services are generally accepted in the chiropractic community and chiropractors are entitled to provide such services and to be paid appropriate benefits under Aetna's plans.

The Complaint seeks: (1) to stop Aetna from continuing to engage in impermissible audit and recovery practices; (2) to stop Aetna from enforcing clinical policies that are substantively baseless; (3) compensation for chiropractors who have been coerced into making payments to resolve or defend against Aetna's unlawful overpayment actions; and (4) compensation for chiropractic trade associations, like the ANJC, who have devoted significant time and resources dealing with these various improprieties.