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Aetna Sues Six New Jersey Physicians for Out-of-Network Claims

Aetna is suing six New Jersey physicians who allegedly filed out-of-network claims for patients admitted to in-network hospitals, according to a report by the Record.

The lawsuits, filed separately during the past eight months, seek triple damages under state insurance fraud laws, alleging the physicians violated rules against excessive fees set by the New Jersey Board of Medical Examiners. Patients were not informed of the physicians' out-of-network status and were never told of the fees, the lawsuits state.

An Aetna spokeswoman said patients referred to in-network hospitals received care from out-of-network physicians who have no contracts and set their own charges. She said the six physicians were reimbursed $8.3 million in 2009, up from $4.9 million in 2008.

Responding to one of the lawsuits, an attorney for a physician said, "It's a naked attempt to extort millions of dollars from a practitioner with an impeccable patient care record." He said a counterclaim has been filed.

Read the Record report on out-of-network payments.

Read more coverage of out-of-network claims in New Jersey:

- 4 Thoughts on the Future of Out-of-Network in New Jersey


- New Jersey Out-of-Network Bill Passes Assembly


- Revised New Jersey Out-of-Network Bill Released; NJAASC Views Changes as Positive


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