Aetna sues COVID-19 testing company, alleging fraud

Aetna is taking a group of related radiology companies to court and accusing them of charging at least $580,000 for unauthorized COVID-19 testing.

The insurance company, a subsidiary of CVS Health, filed a lawsuit in the U.S. District Court of New Jersey on Wednesday. According to Aetna, RP and Vestibular Diagnostics’ Open MRI and imaging are seeking with founder Salvatore Conte and executive Eugene DeSimone Profit from the COVID-19 pandemic By transforming the laboratory into a test site in the spring of 2020. Conte owns two companies that share an address in Rochelle Park, New Jersey. The lawsuit alleges that Conte and DeSimone established two new companies, Universal and Integrated Wellness, at the same address to spread their testing costs and avoid scrutiny.

RP’s open MRI and imaging did not immediately respond to interview requests, and Vestibular Diagnostics could not be contacted by Modern Healthcare.

Aetna’s claim reflects a claim made by Horizon Blue Cross Blue Shield, which is also suing Open MRI and Imaging of RP and Vestibular Diagnostics. The radiology companies also sued Cigna, accusing the health insurance company of falsely refusing to pay nearly US$400,000 for COVID-19 testing. These cases are ongoing.

DeSimone and Conte were trained as doctors, but their medical licenses were revoked due to previous health care fraud. In 2015, the Ministry of Justice sentenced DeSimone to 37 months in prison for accepting bribes from medical laboratories in exchange for referrals for blood tests, and then charging medical insurance and private insurance companies. In 2017, the federal government sentenced Conte Three-year probation and similar patient referral programs are fined $50,000.

According to Aetna, Open MRI and imaging for RP and vestibular diagnosis require rapid COVID-19 testing in unlicensed facilities. The insurance company further claimed that the laboratory misrepresented the type of testing performed and charged a sample processing fee that only applies to PCR testing. The complaint alleges that clinicians have also escalated the claims, and some bills predate the establishment of the new company.

Dr. Raymond Reiter, Doney Jain, George Pemberton and Colin Hermann were also named as defendants for allegedly managing the test.

Aetna accused the institutions and doctors behind it of insurance fraud, common law fraud, negligence, unjust enrichment, and civil conspiracy. The company also sued St. Irene Realty, a subsidiary of Stephen Conte Jr., for aiding and abetting insurance fraud. The lawsuit did not describe what family relationship, if any, exists between Stephen Conte Jr. and Salva Conti.

The lawsuit alleges that Vestibular Diagnostics is apparently transferring all of its cash to Stephen Conte Jr. to demonstrate insolvency and avoid allegations of fraudulent repayment of Aetna.

The insurance company seeks reimbursement for claims paid, litigation and investigation fees, attorney fees, triple damages, and any other expenses the court deems appropriate. Aetna also hopes to issue an injunction to prevent Vestibular Diagnostics from transferring its assets to Stephen Conte Jr. during the trial. The insurance company is seeking a jury trial.

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