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Chiropractors Sue Aetna Over Refund Claims

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The Association of New Jersey Chiropractors has filed a lawsuit against Aetna Inc. for making allegedly improper demands for repayment for some chiropractic services.

AJNC, Branchburg, N.J., is seeking relief from Aetna, Hartford, in a class-action suit filed in the U.S. District Court of New Jersey July 29.

Aetna has refused to cover certain “generally accepted” chiropractic services to some members of its health plans that it deemed to be “experimental and investigational,” the suit says.

In addition, the suit alleges that Aetna’s post-payment audit process violates the Employee Retirement Income Security Act of 1974 and the Racketeer Influenced and Corrupt Organizations Act. It also claims that Aetna has issued clinical policy bulletins to deny services retroactively.

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

Aetna is staying behind its practices and opposing the allegations.

“Aetna takes seriously our obligation to our employees, customers and members to identify healthcare fraud and seek payments from those who abuse the healthcare payment system,” a spokesperson from Aetna says.

AJNC is represented in the suit by Buttaci & Leardi L.L.C., Princeton, N.J., and Pomerantz, Haudek, Grossman & Gross L.L.P., New York.