A federal judge in the U.S. District Court for the Southern District of Florida has dismissed a lawsuit brought by Aetna against Radiology Partners, ruling that the insurer cannot use the courts to unwind arbitration losses under the No Surprises Act.
In an April 16 opinion, the court threw out the case with prejudice, finding that Aetna failed to meet the high bar required to challenge arbitration awards under the Federal Arbitration Act and improperly sought to relitigate disputes already decided through the law's independent dispute resolution process.
Radiology Partners is a national physician services company that works with hospitals and health systems to provide radiology services, including imaging interpretation and clinical support, through a large network of affiliated practices.
Aetna's complaint alleged that Radiology Partners engaged in a "multiphase scheme" to inflate reimbursement. The insurer claimed the group routed claims through an affiliated practice to secure higher in-network rates before shifting to out-of-network billing and filing tens of thousands of disputes through the No Surprises Act's arbitration system. Aetna also alleged that some claims were misrepresented as out-of-network services. In one example cited in court filings, a $78.89 in-network service resulted in a $752 payment after arbitration. The insurer argued the strategy generated millions of dollars in awards and sought to have those decisions vacated, block future arbitration filings and recover damages.
The court rejected those arguments, emphasizing that arbitration outcomes are entitled to significant deference. Under federal law, courts may only overturn arbitration awards in limited circumstances, such as fraud or arbitrator misconduct. The judge found that Aetna's claims did not meet that threshold and noted the insurer had prior knowledge of the billing practices but failed to raise those concerns during arbitration. Allowing the case to proceed, the court said, would undermine the finality of the arbitration system.
The ruling centers on the No Surprises Act, which protects patients from unexpected medical bills by shifting payment disputes to insurers and providers. When negotiations fail, either side may initiate arbitration, where a neutral arbiter selects one of two proposed payment amounts.
In a statement, Radiology Partners said the decision reinforces the integrity of the arbitration process and prevents parties from attempting to overturn unfavorable outcomes in court. Aetna has not publicly commented.
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