Aetna investigating potential 'waste, abuse and fraud' at Cook Children's amid life support controversy

As debate over the cost of providing life support for a 2-year-old intensifies, Fort Worth, Texas-based Cook Children's said third-party administrator Aetna's Special Investigative Unit has launched a review, reports The Fort Worth Star-Telegram.

Two-year-old Tinslee Lewis was born with a rare heart condition and has been at Cook Children's for most of her life. She has been kept alive with "extreme efforts," the hospital said in an April 16 appeal, in which it asked for a quickly scheduled trial date to determine whether life support care can be ended.

In the hospital's most recent motion, it said Aetna's investigative unit has requested all of Tinslee's records. Under Medicaid regulations, the Special Investigative Unit's mandate is to investigate "waste, abuse and fraud," according to the hospital motion.  

"In Cook Children's experience, such reviews are often precursors to efforts to deny payment or even claw back funds previously paid," the motion said, as cited by the Star-Telegram. 

Trinity Lewis, Tinslee's mother, has argued that her daughter could get better and the hospital shouldn't be able to decide her fate. Tinslee breathes with a ventilator and is sedated but conscious, Ms. Lewis said in January 2020, and responds to touch and stimulation. However, the hospital says Tinslee can't feel anything except pain and has no chance of recovery.

On April 16, the hospital filed an appeal stating that Texas had spent $24 million in Medicaid funds to help keep Tinslee alive. The state is threatening to interject due to the cost, according to Cook Children's. 

Ms. Lewis and her attorneys said they had heard nothing about a potential intervention, while a Texas Health & Human Services Commission spokesperson told the Star-Telegram that the agency hasn't tried to intervene.

In January 2020, a 48th District Court in Fort Worth judge ruled that the hospital could end life support, a decision that was later reversed by the Second Appellate District of Texas in Fort Worth. In October, the Texas Supreme Court denied the hospital's petition to take Tinslee off life support, and in January, the federal Supreme Court also rejected the hospital's plea. The case now returns to the lower court for a final ruling. 

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