Aetna Awarded $51.4 Million Against Hospital for Overcharges and Kickbacks

On February 15, 2017, a federal Judge in Texas confirmed an award of $51.4 million to Aetna Life Insurance Co. against Humble Surgical Hospital. Aetna claimed that the hospital charged Aetna up to 10 times more than typical market rates for services rendered, including $74,000 for bunion surgery and $139,000 to repair a crooked toe. The hospital was out-of-network with Aetna, but encouraged patients to use its services by waiving copayments or charging them in-network fees. The hospital then billed Aetna out-of-network rates. The hospital also paid illegal kickbacks to doctors who referred patients to it through the use of shell corporations that paid the doctors a percentage of facility fees collected from Aetna.

The hospital has filed an appeal of the judgment to the federal appeals court.