California court revives retaliation lawsuit against Aetna

The California Supreme Court has resurrected a case that could impact whether or not insurers can punish physicians for referring patients to out-of-network providers, according to a July 25 report from Medscape.

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The case, which first entered the courtroom in 2012, was filed by the California Medical Association, which alleges that one of the nation’s largest health insurers, Aetna, illegally retaliated against physicians who sent patients to out-of-network clinics. 

On July 17, the California court unanimously agreed to resurrect CMA v. Aetna after an appeals judge killed it claiming that CMA had no standing to sue Aetna. 

The suit alleges that Aetna harassed and fired contract physicians who referred patients to out-of-network ASCs. 

Aetna, now part of CVS Health, has declined to comment on the ruling, according to the report. 

“The practice of threatening physicians who refer patients to out-of-network providers is unlawful, and we are pleased that the court agrees that CMA has the right to challenge these practices in court,” CMA President Donaldo Hernandez, MD, told Medscape. 

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