Judge certifies class action in Aetna, Optum 'dummy code' lawsuit

A federal judge in North Carolina certified class action status June 5 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 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's 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. 

Messages sent to Aetna and Optum seeking comment were not immediately returned. 

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