By Christopher P. Young, Editor, G2 Compliance Advisor
Aetna alleges Health Diagnostic Laboratory, Inc. (HDL), and Bluewave Healthcare Consultants, Inc. used kickbacks and inducements to redirect referrals for laboratory testing to HDL, an out-of-network laboratory, causing Aetna to pay twice as much as it would if equally qualified in-network laboratories performed those tests. Aetna seeks to recover from HDL and Bluewave monetary damages of “tens of millions” of dollars, which it claims they received illegally. This case is part of a growing series of cases involving laboratories that employ similar business practices to overcome exclusive insurance contracts that have potential to significantly impact their ability to compete in the marketplace. A recent U.S. Department of Health and Human Services Office of Inspector General (OIG) Advisory Opinion (15-04) addresses similar issues.
Aetna is the second private insurance company to file suit against HDL. In an Oct. 15, 2014 lawsuit, Connecticut General Life Insurance Co. (CIGNA) accuses HDL of similar fraudulent practices.
The underlying issue in these lawsuits is allegations that HDL and Bluewave used kickbacks in the form of specimen collection and handling fees paid to physicians to induce them to ignore their contractual obligations to refer to in-network laboratories, order unnecessary tests and refer them to HDL. The defendants are also alleged to have paid inducements to patients in the form of forgiving copays and coinsurance to encourage them to get the allegedly unnecessary tests from HDL. Whistleblowers have made claims similar to those on which these payers’ lawsuits are based.
As reported in G2 Compliance Advisor, the government has intervened in cases against Bluewave and two other laboratories that are yet to be decided. Other large private insurance companies such as United Health Care and Humana could file suits depending on their relationships with HDL and other laboratories. Laboratory compliance officers should follow these cases because of the implications they have on laboratories and managed care contracts.