North Cypress Medical Center Wins Legal Case against Aetna Life Insurance Company
Federal District Court Rejects Aetna's $225M Lawsuit, Finds for Northwest Houston Hospital
CYPRESS, Texas, June 22, 2016 /PRNewswire/ -- North Cypress Medical Center has been awarded a resounding legal victory in a case against Aetna Life Insurance Company. In a decision issued on June 15, 2016, the United States Senior Judge, Kenneth Hoyt of the Southern District of Texas, found no merit in Aetna's allegations that North Cypress Medical Center had committed common law fraud, healthcare fraud or misrepresentations in over 44,000 claims at issue. The allegations were fully rejected by the Court, and the Court refused to award any of the $225 million in damages sought by Aetna from North Cypress. The Court found that there is not "a scintilla of evidence of fraud" on the hospital's part and that North Cypress Medical Center did "not engage in fraudulent conduct."
In North Cypress Medical Center, et al. v. Aetna Life Insurance Company, Aetna was sued for the improper reimbursement of healthcare claims by a general acute care hospital and in response, Aetna counterclaimed for alleged overpayments on more than 44,000 claims amounting to over $225 million. This three-week jury trial was completed on May 6, 2016.
After hearing the testimony of nine witnesses and reviewing over 600 trial exhibits, the United States District Court ruled that:
- There was no fraud on the part of North Cypress with regard to any health claims submitted to Aetna (not "a scintilla of evidence").
- North Cypress made no misrepresentations of fact to Aetna at any time.
- North Cypress' Prompt Pay Discount Policy does not violate any federal or state laws and was fully and properly disclosed to Aetna.
- North Cypress violated no state or federal laws with regard to any of its business practices, and Aetna suffered no losses or damages with regard to the 44,000+ health claims submitted by North Cypress to Aetna over the four-year period at issue.
- All of Aetna's claims were dismissed by the Court with prejudice.
"After an all-out, specious legal assault by Aetna against our ten-year-old general acute care hospital, the Court has affirmed what we knew all along: North Cypress' administrative and management practices do not violate any federal or state laws," said North Cypress Founder and Chief Executive Officer, Robert A. Behar, M.D. "Truth and facts were our defense."
"This was a classic case of overreach and corporate bullying by a national insurance company intent on forcing healthcare providers to bend to its money-grabbing tactics, disallowing charges, inventing new rules suddenly and moving the goal posts regularly on us. On behalf of our patients, payers and talented medical staff, North Cypress refused to comply with Aetna's unethical demands and we aggressively and successfully defended our management practices and quality healthcare delivery principles," continued Behar.
In an interesting trial rebuke, the Court "struck" the expert testimony and opinions of Mary Beth Edwards, a representative and consultant with Navigant Consulting, Inc. in Washington, D.C. Edwards was hired by Aetna to present a damage model of Aetna's alleged, calculated damages. The record indicates that Navigant charged more than $300,000 for the work performed by Edwards and others at Navigant. The Court in its ruling said Edwards' testimony was "truly prejudicial and as established by her testimony a built-in bias that had nothing to do with the evidence presented."
North Cypress Medical Center's litigation team is composed of lead counsel, J. Douglas Sutter of Kelly, Sutter & Kendrick, P.C. and Neil L. Prupis of Wilson, Elser, Moskowitz, Edelman and Dicker LLP.
About North Cypress Medical Center
North Cypress Medical Center is a 175-bed physician-owned, general acute care hospital, founded by local physicians who wanted to create a sophisticated, upscale, patient-friendly healthcare environment for their community. Services include the latest, state-of-the-art medical technology and equipment, well-respected area physicians, and an upscale 5-star hotel-like patient experience.
About Robert A. Behar, M.D.
Dr. Robert A. Behar is the Founder, Chairman of the Board and Chief Executive Officer of North Cypress Medical Center. North Cypress is a Tertiary General Acute Care Hospital located in Northwest Harris County. Dr. Behar has grown this entity over ten years from a startup to a comprehensive medical center with over $2 billion in revenues and 1,200,000 square feet of improvements on 60 acres of land on four separate campuses.
In addition to managing the hospital, Dr. Behar practices medicine and serves as Director of the hospital's Cancer Center. A respected leader in his field, Dr. Behar earned his undergraduate degree from the University of Chicago with Honors (at the age of 19) and went on to become the youngest medical student in his class at the University of Chicago's Pritzker School of Medicine. He went on to intern at Northwestern University and completed his residency in Radiation Oncology at Stanford University where he was also the Chief Resident and named the American Cancer Society Research Fellow in Clinical Oncology. Dr. Behar has been involved in many Houston medical "firsts" such as Ultrasound Guided Transperineal Radioactive Palladium Seed Implants for Prostate Cancer, Photon Knife Radiosurgery for Inoperable Brain Tumors and Stereotactic Body Radiosurgery to cure previously untreatable cancers throughout the body. Dr. Behar also holds a MBA with Honors in Finance from the University of Chicago Booth School of Business.
CONTACT:
Scott Dunaway
[email protected]
(512) 344-2611
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SOURCE North Cypress Medical Center
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