A class action suit was filed July 29, 2009 in U.S. District Court, District of New Jersey by Buttaci & Leardi, LLC and the renowned class action law firm of Pomerantz Haudek Grossman & Gross LLP. These firms have been retained by the Association of New Jersey Chiropractors (ANJC) on behalf of it’s membership, chiropractors and other health care providers. The suit alleges that Aetna’s post-payment audit process is violative of the Employee Retirement Income Security Act of 1974 (‘ERISA’). It further alleges that Aetna’s post-payment audit process and its pre-payment claim review process violate the Racketeer Influenced and Corrupt Organizations Act (‘RICO’) and calls into question the retroactive application of Aetna’s clinical policy bulletins in order to deny provided services previously paid under their claims. These clinical policy bulletins are being used as the basis for demanding refunds of payments for services rendered, and previously determined as payable, as experimental and/or unproven to be clinically effective.
Further information about the suit (case # 3:09-CV-03761-JAP-TJB) can be found through the following links;