Unmasking a Healthcare Scandal: Aetna vs. Radiology Partners 💼⚖️ & Savvy Imaging Choices! 🏥💡

Aetna's lawsuit against Radiology Partners sheds light on excessive billing practices in the medical imaging industry, revealing the importance of choosing independent clinics for better pricing and quality. This episode explores the implications for patients and encourages informed choices in their healthcare decisions. 
• Aetna's legal action against Radiology Partners for fraudulent billing practices 
• Exploration of the historical context of Radiology Partners' operations 
• The financial impact on consumers and the importance of independent imaging centers 
• Recommendations for choosing where to get medical imaging 
• Insight into healthcare transparency and the need for consumer advocacy

Music by Alex Lambert.

Contact Justin via text 740-525-5259 or via email JFutrell@TrueNorthCompanies.com

I welcome the opportunity to hear your feedback from this episode!

Thanks again to my musically gifted friend Alex Lambert for the music. Also thanks to Kevin Asehan for the edits.

Transcript

Speaker 1: 0:19

Welcome to another Tuesday Morning with Justin. I'm Justin Futrell, benefit Advisor at True North. Today, I want to dive into a half headline and the other half a question from a listener. So the headline is Aetna sues radiology partners over billing shenanigans in Florida partners over billing shenanigans in Florida. So what's going on? There's an Aetna.

Speaker 1: 0:49

Aetna filed a lawsuit against radiology partners, alleging that radiology partners implemented a fraudulent scheme that has inflated the cost of their services in Florida by tens of millions of dollars by tens of millions of dollars. In other words, after several years, aetna finally figured out that they sent millions of dollars in excess billing to radiology partners. How did it happen? Well, radiology partners started figuring out who had the best contracts with Aetna and started acquiring them and then getting the other providers to move over to that contract financial arbitrage, if you will. Now, in 2022, aetna terminated that contract, so radiology partners can no longer do that. And there's all of this legal back and forth. Blah, blah, blah. It seems like Radiology Partners has a way out because of the new no Surprises Act. But the importance of this is well, how did this happen? That's my first question. How did this happen? That's my first question. How did this happen, and if you go back to 2014,. Radiology Partners was described as a new image of healthcare, working to transform radiology by partnering with a national network of radiology experts and applying a modern tech stack to streamline operations and improve care. Sounds great, pretty nice vision, but in the end, radiology partners took advantage of negotiated rates and contracts and how they could maximize their profitability.

Speaker 1: 2:36

So it leaves me with the question from a listener coming to the forefront of my mind, and that is like if I need imaging a very practical question if I need medical imaging, where should I go? And the answer to that is find an independent medical imaging center near you. How do you do that? Well, one of the best examples is Green Imaging. They have clinics across the entire country. I think they even have 35 in Rhode Island last time I checked. So there's a good chance there is one near you. Why would you go to an independent medical imaging clinic?

Speaker 1: 3:21

Well, gang, if you think about it, it doesn't matter whether an MRI machine is at this small green imaging clinic or whether it's inside the four walls of the nicest hospital you've ever walked into. The MRI machine is accomplishing the same thing, is accomplishing the same thing, unless it's extremely antiquated equipment. There's no reason that you should step inside the four walls of a hospital or something that's owned by a hospital, or else you're instantly going to be paying more money out of your own pocket. But this leads us to an interesting thought and it takes me back to a client I was reviewing recently, before we took them over as a client. Their average MRI cost was $3,300 for the entire year, like 700 people enrolled on their plan. $3,300 on average plan. $3,300 on average.

Speaker 1: 4:26

Okay, I didn't go to a green imaging, but a similar independent clinic in a month ago for an MRI. It was $680. $680 compared to $3,300, which makes me wonder, and I'd love to hear your feedback If your employer, if your company, offered to give you a free medical imaging, a free MRI, if you went to one of a handful of places, would you go or would you continue to go wherever the emergency room recommended you to? That's probably within a hospital system. I think this is one way. I know that this is one way we can impact change and drive waste out of our healthcare system.