On February 23, 2015, Aetna filed suit in Texas federal court against Robert A. Behar, M.D. and North Cypress Medical Center (North Cypress), alleging that Dr. Behar, the CEO of North Cypress, offered impermissible ownership stakes in the 139-bed community hospital in exchange for patient referrals and designed an out-of-network business strategy that gave rise to excessive fees charged to Aetna. Now North Cypress has struck back.

On August 11, 2015, North Cypress answered Aetna’s complaint denying the allegations, and in addition, filed an original counter-complaint against Aetna and its officers, Mark T. Bertolini, Jeff D. Emerson, Ed Neugebauer, and Clarence Carlton King, for what North Cypress described as “instigating unlawful and illegal decade-long schemes and ‘Major Initiatives’ against physician-owned, out-of-network facility providers such as North Cypress…”

North Cypress contends Aetna’s schemes were perpetrated in order to “‘bring down,’ ‘destroy’ and bankrupt those entities” so that Aetna could realize greater revenues. Aetna’s alleged schemes purportedly involved Aetna making contingency fees of “25% to 50% of the ‘Savings’ that Aetna artificially creates in the adjudication of out-of-network claims…” North Cypress claims Aetna’s actions come at the expense of employer plan sponsors of self-funded plans and out-of-network providers. In carrying out its schemes, which are alleged to violate both state and federal law, North Cypress contends Aetna collected billions of dollars of net revenue per annum.