The 4th Circuit Court of Appeals reversed a decision June 22 that puts Aetna and Optum back in hot water for allegedly using "dummy code" that disguised administrative charges as billable medical fees.
While plaintiff Sandra Peters did not lose money in the alleged affair due to coinsurance limits, the appellate court found that it is possible Aetna conducted a "breach of its fiduciary duty" in burying administrative fees, and Optum utilized unauthorized transactions, according to court documents.
Appellate judges sided with Ms. Peters, therein restoring the right to sue the companies after the hidden charges allegedly more than doubled her coinsurance payments, as well as fees collected from her insurance plan, according to court documents.
In the reverse ruling, judges sided with Ms. Peters' initial claim that the alleged offense is a violation of the Employee Retirement Income Security Act. Ms. Peters aims to represent two parties: herself and her company's, Mars, self-funded insurance plan.
The initial lawsuit was first made by Ms.Peters in 2015.
Aetna and Optum have not replied to requests for comment.