Columbus, Ohio HME provider network CareLink has sued insurance giant Aetna U.S. Healthcare for $9 million in alleged unpaid claims for HME services.

Citing more than a year of attempts to receive reimbursement from Aetna, CareLink filed a complaint January 29 in the Court of Common Pleas of Summit County, Ohio. The suit alleges "breach of contract, fraudulent misrepresentation, bad faith termination and unjust enrichment."

An Aetna spokeswoman said the insurer disagrees with the allegation raised in the complaint and intends to defend the lawsuit vigorously.

CareLink, which has more than 150 HME provider members, began providing respiratory, mobility and home health services to Aetna beneficiaries in April 1996. "At first, it was going fine," said Thomas Hess, counsel for CareLink. "Payment was being received, though not as quickly as one would hope." Payment difficulties began in mid-1997, he said.

The complaint also alleges that Aetna made fraudulent promises regarding the insurer's intent to pay unpaid claims. According to the complaint, in March 1998, Aetna acknowledged the payment problems and promised to resolve the issue of how much it owed CareLink by August 15, 1998. The deadline was then extended to September 1998, when Aetna officials said they would immediately pay all claims with an individual value of $200 or less. CareLink alleges payment was never received.

"Aetna has known of the problem since at least January 1998," Hess said. "They acknowledged the problem was on Aetna's side and said that there had been no service problems on CareLink's side."

In December 1998, Aetna told CareLink it was going to terminate its contract with the group on March 31, 1999. "They gave no reason for terminating the contract," Hess said. "The only thing we have been told is that they felt it may be best so that accounts receivable don't keep increasing."

CareLink president Mario LaCute said the network "looks forward to having the opportunity to prove our case in a court of law."-K.S.