Aetna settles lawsuit alleging its ex-medical director didn't review patient records before denying claims

Aetna settled a lawsuit after a former medical director said under oath that he didn't review patients' medical records when making coverage decisions, according to CNN.

The testimony, first reported by CNN in February 2018, prompted California's former insurance commissioner to launch an investigation into the insurer's policies. At the time, Aetna said it would fight the case and argued that the medical director's comments were decontextualized.

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.

Aetna, now a CVS Health-owned company, didn't say why it decided to settle the lawsuit rather than defending its policies in court, according to CNN. The terms of the agreement weren't released. The settlement came in late March, ahead of a scheduled trial, the parties told CNN.

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