Zelis, Aetna Fail to Shut Down Health Payment Suppression Claims

Boston-based Zelis Healthcare LLC and large insurers including Aetna Inc. Humana Inc., and Cigna Corp. failed to toss allegations that they colluded to push down reimbursements for providers’ claims submitted for out-of-network services.

The plaintiffs sufficiently alleged antitrust standing and injury in the case, Judge Brian E. Murphy of the US District Court for the District of Massachusetts held in a Monday ruling that denied the defendants’ joint motion to dismiss.

The providers adequately alleged the “rim of their alleged hub-and-spoke conspiracy through circumstantial allegations,” Murphy said, referring to claims that Zelis is the hub that coordinated communication between competitors ...