Aetna, Optum can't escape class-action status in 'dummy code' case

The 4th U.S. Circuit Court of Appeals said Sept. 13 it won't review a lower court's ruling that certified class-action status in a lawsuit alleging Aetna and OptumHealth Care Solutions conspired to use "dummy code" to make administrative fees appear to be billable medical charges.

The three-judge panel unanimously denied Aetna and Optum's request to review a North Carolina federal judge's June decision to certify class-action status, according to court records. The judges did not provide an explanation for their decision in the order. 

The lawsuit, which was originally filed in 2015, alleges the two insurers tricked plaintiff Sandra Peters, other patients similarly situated and their employers into paying administrative fees by disguising them as medical expenses. The lawsuit alleges the defendants violated the Employee Retirement Income Security Act. 

The two classes certified by the judge could cover more than 87,000 health plan participants, according to court records. 

A judge initially ruled in Optum and Aetna's favor in 2019, but a federal appeals court reversed the decision in 2021, finding that Aetna conducted a "breach of its fiduciary duty" in burying administrative fees and that Optum utilized unauthorized transactions.

The Supreme Court denied Optum's bid to drop the lawsuit last year

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