Aetna, Optum must face 'dummy code' lawsuit, Supreme Court rules

The Supreme Court denied Optum's bid to drop a class-action lawsuit that alleges the company worked with Aetna and used "dummy code" to make administrative fees appear to be billable medical charges. 

The court denied OptumHealth Care Solutions' writ of certiorari on March 7. The class-action case will be sent back to the Fourth Circuit Court of Appeals for a decision.

OptumHealth and Aetna must defend allegations brought by plaintiff Sandra Peters. The lawsuit, which was filed in 2015, alleges the two insurers tricked Ms. 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 Securities Act. 

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

OptumHealth had requested the Supreme Court review the appellate court decision. 

Becker's Hospital Review's request for comment from Optum and Aetna was not returned by the time of publication. 

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