Health insurance giant Aetna under legal fire from New York City Cardiologist

NEW YORK, May 29, 2018 /PRNewswire/ -- A New York cardiologist, Dr. Perry Frankel, is suing Aetna for breach of contract with his practice, Advanced Cardiovascular Diagnostics (ACD) in a lawsuit filed today, May 29, 2018. The suit, filed with the Supreme Court of the State of New York, County of New York, is the result of a year-long battle to pay out nearly $1 million worth of legitimate claims for Covered Services of Aetna plan members. Aetna ordered ACD to cease all medical care provided specifically by its mobile clinic in May 2017. The lawsuit follows a protest outside of the Aetna building in New York earlier this month. Dozens of Black and Latino union and city workers affected by the blackballing of ACD screenings, proven to save lives, urged Aetna to reinstate ACD coverage to their plans. ACD made repeated attempts to ask Aetna why it honored claims for some ACD services and refused others, but never received an explanation. Soon after, Aetna dropped Dr. Frankel as a provider altogether, leaving hundreds of members claims unpaid.

“Aetna’s reckless behavior has already compromised the health and well-being of thousands,” said Dr. Perry Frankel, President and chief cardiologist of ACD. “This is life-or-death for countless members whose claims have been denied without cause or explanation.”

ACD mobile clinics provide important on-site cardiac screenings at union and church locations in medically underserved communities across New York City. This prompted Black and Latino union leaders and rank and file patients of Dr. Frankel’s to rally outside of the Park Avenue Aetna headquarters in a protest, which took place on May 9, 2018, one year after Aetna first ordered ACD stop mobile clinic visits. “Aetna’s sudden refusal to pay more than $900,000 of medical claims for hardworking union and city workers under their coverage is nothing more than corporate greed and discrimination,” said Attorney Todd Cushner of Cushner & Associates, P.C., the firm representing Dr. Frankel and ACD in the suit. “My client has faithfully honored his agreement [Specialist Physician Agreement Execution Sheet] since 1998, but the same cannot be said for Aetna who is effectively restricting access to lifesaving healthcare from municipal workers.”

The complaint cites Breach of Implied Covenant of Good Faith and Fair Dealing which is a violation of New York law. Other infractions Aetna could be found guilty of:

• Patient Protection and Affordable Care Act, 42 U.S.C § 80001, et seq. ,
• New York Public Health Law § 4406(1);
• New York Public Health Law § 4406-(d)(2)(a);
• New York Public Health Law § 4406-(d)(2)(d);
• New York Public Health Law § 4406-d(5);
• New York Insurance Law § 3224-a (the Prompt Payment Law);
• New York Insurance Law § 4803(b)(1).

CONTACT: Hank Sheinkopf (212) 725-2378