Local hospitals plan to sue Aetna U.S. HealthCare – and perhaps other HMOs – charging they illegally refuse to pay for $1 billion in services, The Post has learned.
The lawsuit in state Supreme Court will charge that Aetna has shafted 175 hospitals and nursing homes by not paying for services rendered, sources said.
“We’re not going to take it anymore,” Greater New York Hospital Association President Ken Raske declared yesterday.
“We are going to initiate a broad-based legal challenge,” he told officials at the Sheraton-New York.
The hospital group estimates that Aetna and other HMOs have left local facilities hanging for $1 billion in unpaid or denied claims.
Aetna, the largest U.S. HMO, settled a landmark case in Texas this week, agreeing to stop paying bonuses to doctors who stayed within their tight budgets. Texas had sued Aetna and other HMOs.
Raske would say no more about the planned action here, but insiders confirmed the group is ready to “fire that gun.”
“What we’re looking at is really something – the late payments, denials. Taken together, they’ve demonstrated a pretty concerted effort not to pay,” said one source.
“At some point, it crosses the line into fraud and unfair trade practices,” the official said.
Aetna spokeswoman Elizabeth Sell said the company didn’t know of any planned lawsuit here. “Our door is always open to discuss issues as they arise,” she said, adding that Aetna is in “productive discussions” with some area hospitals.
U.S. attorneys in other states are eyeing lawsuits, but New York Attorney General Eliot Spitzer hasn’t jumped on board.
“We have an inquiry into Aetna, and we’re looking at the same stuff,” said Spitzer spokesman Scott Brown.