OptumHealth has pulled out of its agreement to settle a class-action lawsuit alleging the company and Aetna used a "dummy code" to inflate workers' medical expenses.
The UnitedHealth Group subsidiary withdrew from the agreement after "it became clear that Optum's understanding of one of the negotiated terms was inconsistent with the understand of the Settling Parties," according to a Dec. 6 notice filed with the U.S. District Court for the Western District of North Carolina. Aetna remains in agreement with the settlement made in November, according to the filing.
Related: Aetna, Optum to settle 'dummy code' class-action case
The suit pertains to a nine-year-long dispute between the companies and plaintiff Sandra Peters, a retiree covered under an employer-sponsored Aetna policy, who alleges Aetna and OptumHealth did not follow the Employee Retirement Income Security Act of 1974, which governs employee benefits such as large-group health plans.
Court discovery included emails between the two companies that showed an agreement to begin using an extra service code on patient bills. The so-called "dummy code" allegedly entered administrative costs as medical costs, leading to higher out-of-pocket expenses for members.
CVS Health's Aetna and the class, which has grown to include 87,700 people and nearly 2,000 health plans, jointly requested in the new filing that pretrial and trial proceedings between the class and Optum be deferred until the settlement receives final approval from the court.
"Aetna would face significant potential prejudice from a separate trial against Optum, in which Aetna could be impacted but in which it did not participate," the filing reads. "As a practical matter, until its settlement with [the class] is complete Aetna will have no choice but to participate in any trial of merits of this action --- a consideration that necessarily would compromise and undermine the settlement."
A district court ruled in favor of Aetna and OptumHealth in 2019, stating the companies met ERISA standards. The ruling was reversed by the U.S. Court of Appeals for the 4th Circuit in 2021 and later Aetna and OptumHealth were denied a Supreme Court review of the case in 2022.
Both OptumHealth and Aetna did not immediately respond to a request for comment.
