Colorado, Washington and Connecticut have joined California in investigating Aetna after one of the health insurer's former medical directors admitted under oath he never reviewed patients' medical records when deciding whether to approve or deny claims, according to CNN.
Jay Iinuma, MD, who served as medical director for Aetna for Southern California from March 2012 through February 2015, said in a 2016 deposition he followed Aetna's training by relying on recommendations from nurses when deciding whether to approve or deny care. After recently reading the deposition transcript, California Insurance Commissioner Dave Jones launched an investigation into the health insurer's practices.
Aetna, which has 23.1 million members, said the comments in the deposition were "a gross misrepresentation of how the process actually works" and were "taken out of context." Aetna also released a sworn statement by Dr. Iinuma, in which he said he reviewed relevant portions of patients' records, according to CNN.
Dr. Iinuma's deposition came as part of a lawsuit filed by a 23-year-old college student, Gillen Washington. Mr. Washington, who suffers from a rare immune disorder, sued Aetna for breach of contract and bad faith after Aetna refused to cover an infusion of intravenous immunoglobulin when he was 19. He claims Aetna's "reckless withholding of benefits almost killed him."
On Feb. 14, Connecticut became the fourth state to launch an investigation of Aetna.
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