Hospital Wins Case Against Insurance Company

North Cypress Medical Center has been awarded a legal victory in a case against Aetna Life Insurance Company, according to a press release from the health system.

In a decision issued on June 15, 2016, the United States Senior Judge, Kenneth Hoyt of the Southern District of Texas found no merit in Aetna’s allegations that North Cypress Medical Center had committed common law fraud, healthcare fraud or misrepresentations in over 44,000 claims at issue.

The allegations were fully rejected by the Court; and the Court refused to award any of the $225 million in damages sought by Aetna from North Cypress. The Court found that there is not “a scintilla of evidence of fraud” on the hospital’s part and that North Cypress Medical Center did “not engage in fraudulent conduct.”

In North Cypress Medical Center, et al. v. Aetna Life Insurance Company, Aetna was sued for the improper reimbursement of healthcare claims by a general acute care hospital and in response, Aetna counterclaimed for alleged overpayments on more than 44,000 claims amounting to over $225 million, the press release notes. This three week jury trial was completed on May 6, 2016.

“After an all-out, specious legal assault by Aetna against our ten year-old general acute care hospital, the Court has affirmed what we knew all along:  North Cypress’ administrative and management practices  do not violate any federal or state laws,“ said North Cypress Founder and Chief Executive Officer, Robert A. Behar, M.D. “Truth and facts were our defense.”

“This was a classic case of overreach and corporate bullying by a national insurance company intent on forcing healthcare providers to bend to its money-grabbing tactics, disallowing charges, inventing new rules suddenly and moving the goal posts regularly on us. On behalf of our patients, payers and talented medical staff, North Cypress refused to comply with Aetna’s unethical demands and we aggressively and successfully defended our management practices and quality healthcare delivery principles,” said Robert A. Behar, MD, founder and CEO, North Cypress Medical Center.

About The Author