Aetna Medical Director Admits He Doesn’t Review Medical Files Before Denying Claims

An Aetna “Fake Accounts” Level Scandal? Medical Director Admits He Never Reviewed Medical Records Before Denying Care

By Yves SmithFebruary 13, 2018

CNN managed to get the attention of California’s insurance regulator Dave Jones over a bombshell admission in a suit against Aetna over the denial of care.1 From a videotaped deposition, as summarized in MedCity News Aetna’s former medical director Dr. Jay Ken Iinuma, whose job was to review whether to authorize payments:

He went on to admit he never looked at patients’ records at Aetna and instead relied on information provided by a nurse. Most of his work, he said, was found online. During any given month, Iinuma said he’d call a nurse “zero to one” times to gather more data.

Iinuma was a medical director at Aetna from 2012 to 2015. Commissioner Jones was so outraged over the testimony that he has not only opened up an investigation but is also soliciting information from other Aetna patients who believe they were treated improperly. The state insurance departmetn site urges “any Californians who are concerned that they might have been affected to contact the California Department of Insurance at 1-800-927-4357.” If you have trouble getting through, they also have a “File a Complaint” page.

Medical professionals were stunned by Iinuma’s admission. From the CNN story:

Continue reading.

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