WEBSTER, Texas – Could the downfall of Bay Area Regional Medical Center that led to hundreds of people losing their jobs and patients being transferred to other hospitals have been caused by an elaborate pass-through billing scheme?
That's what insurance giant Aetna claims in a recently filed lawsuit.
Here’s what you need to know:
1. Is Bay Area Regional Medical Center, known as BARMC, being sued by Aetna?
No, Aetna did not name BARMC as a defendant in its lawsuit. But the insurance giant claims the Webster hospital agreed to kickbacks for letting a Houston based lab, ESA Toxicology, use its name in billing.
Aetna is suing ESA Toxicology, along with several other defendants.
2. What does the lawsuit claim?
That there was an elaborate pass-through billing scheme.
One of the parties named in the lawsuit is Houston-based ESA Toxicology.
We spoke with former U.S. District Attorney Kenneth Magidson about it.
“Basically this case, they're alleging that they were bribes paid from doctors and others to send urine and blood and saliva specimens to this particular lab, which was out of network, on behalf of Aetna,” said Magidson.
The suit claims ESA, along with Dallas-based Southwest Laboratories, would pay doctors bonuses or monthly dividends (sometimes as high as $30,000 a month) for a high volume of specimens sent to its testing sites.
3. What does BARMC have to do with this?
Aetna claims BARMC entered into a kickback agreement with ESA Toxicology. The lawsuit alleges ESA then billed Aetna, using BARMC's name, which allowed the claim payments to be higher.
Here's how Aetna explains it:
An Aetna member in El Paso goes to a doctor in El Paso.
That doctor orders a test of a specimen and sends it to ESA labs.
ESA puts in a claim under BARMC, although the insurance company claims the patient never went to the hospital and the hospital never performed the test.
Aetna claims it was then billed nearly $10,000.
4. What does Aetna say its damages are?
Aetna says the improper claims top $50 million.
5. Is anyone commenting?
BARMC and ESA Toxicology did not respond to our requests for comment.
Aetna said the insurance company does not comment on pending litigation.