Another insurance company has filed a lawsuit seeking potentially millions of dollars in damages against the Richmond-based blood testing company Health Diagnostic Laboratory Inc.
Aetna Inc., a Hartford, Conn.-based health insurer, said it is seeking “tens of millions in monetary damages” for what it claims was a “fraudulent billing scheme” by HDL and its former contract sales provider.
HDL, which has it main office and laboratory in downtown Richmond, already is fighting a similar lawsuit filed in October by insurer Cigna Health and Life Insurance Co.
A spokesman for HDL said the company does not comment on threatened or pending litigation. HDL has not yet filed a response to the Aetna lawsuit in federal court.
Both lawsuits attack HDL for the same allegations that resulted in the company agreeing to settle a U.S. Department of Justice investigation earlier this month.
Without admitting wrongdoing, HDL agreed to pay $47 million to resolve allegations that it paid kickbacks to physicians to send blood samples to its laboratory for testing.
Aetna’s lawsuit, filed April 10 in the U.S. District Court for the Eastern District of Pennsylvania, does not state a precise amount of monetary damages the company is seeking, saying only that the amount exceeds $150,000.
The lawsuit also names as a defendant Bluewave Healthcare Consultants Inc., HDL’s former contract sales firm based in Alabama.
The claims in Aetna’s lawsuit are similar to those in the Cigna lawsuit, which alleges that HDL conducted a “fraudulent fee-forgiving scheme.” Cigna is claiming $85 million in damages, but HDL is seeking to dismiss the lawsuit.
The Aetna lawsuit says that HDL’s payments of “processing fees” to physicians to send blood samples resulted in doctors ordering more blood tests than necessary. The payment amount was $17 more than the $3 Medicare reimbursement per blood sample.
“Over the course of years, defendants (HDL and Bluewave) implemented a fraudulent billing scheme that included paying illegal kickbacks to physicians, providing unlawful inducements to patients, and encouraging physicians to order unnecessary blood tests, resulting in fraudulent and inflated medical claims being submitted to Aetna for reimbursement,” the lawsuit claims.
The lawsuit also accuses HDL of fraud because the company waived patient co-payments for blood tests conducted by HDL, which was an out-of-network provider for Aetna customers.
“This was done solely to induce the referral of the business to HDL, instead of to an in-network laboratory,” the lawsuits says.
Aetna claims that HDL never disclosed the patient discounts. “The inflated, billed charges submitted by HDL thereby caused Aetna to pay more for HDL’s services than Aetna would have otherwise paid had it known of the patient discounts,” the lawsuit says.
Bluewave Healthcare Consultants sold HDL’s services to medical practices outside of Virginia. In January, HDL terminated its contract with Bluewave and said it would establish its own national network of sales representatives.
Earlier this month, HDL won dismissal of a lawsuit brought by Bluewave.
After settling the Department of Justice probe, HDL said it had taken “decisive actions to return to its core mission of fighting cardiovascular disease and diabetes with innovative, advanced testing that can lead to earlier diagnosis and treatment.”
Richmond-based Health Diagnostic Laboratory Inc. will pay $47 million to settle claims that …
The legal cloud has lifted, but the company must now get its business plan back on track.