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Fourth Circuit Revives Dummy-Code Lawsuit Against Aetna and Optum
Reuters Link to more items from this source
June 23, 2021

"[The Fourth Circuit] reversed a ruling for Aetna Inc. and OptumHealth Care Solutions, reviving a potential class action alleging that they agreed to use a 'dummy code' to disguise unbillable administrative fees as billable medical treatment.... The [court] agreed that [the plaintiff] herself had not lost money ... However, she 'produced sufficient evidence to create a genuine issue of material fact' as to whether the arrangement violated Aetna's fiduciary duties to the plan and its participants, and whether Optum was an 'interested party' who engaged in a prohibited transaction[.]" [Peters v. Aetna, No. 19-2085 (4th Cir. Jun. 22, 2021)]

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