Earlier this year, a California jury awarded Aetna over $37 million in damages after determining that a network of northern California ambulatory surgery centers (ASCs) overbilled the insurer for out-of-network procedures. The ASCs had recruited patients by waiving copays and other fees and by selling ownership in the facilities to referring physicians.
In this case, the jury felt that the physicians' actions rose to the level of insurance fraud. Yet ASCs have other ploys that don't quite reach that threshold, but can still hit self-insured employers with enormous bills.
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