Kraft Heinz drops claims data lawsuit against Aetna

Kraft Heinz has voluntarily dismissed a lawsuit against Aetna alleging the payer breached its fiduciary duties and used its role as third-party claims administrator for Kraft's employee health plan "to enrich itself" to the food manufacturer's detriment.

The Kraft Heinz employee benefits group representing the company's employees, retirees and their dependents said its claims will move to arbitration, according to federal court documents filed in Texas on Dec. 14.

Kraft filed its complaint against the CVS Health subsidiary in June, alleging the company had taken more than $1.3 billion from Kraft to pay providers, pocketed millions of dollars in undisclosed fees and engaged in claims processing practices that harmed Kraft, including a non-human review process.

Aetna has served as a TPA for Kraft's medical and dental plans since at least 2007. Kraft said it began attempting to retrieve its medical claims data in 2021, which resulted in "self-selected and edited" data from Aetna. In 2022, Kraft said Aetna provided medical and dental data that "proves Aetna breached its fiduciary duties to Kraft Heinz" because it was incomplete and applied to only a select timeline.

"All [claims data] is in Aetna's possession, custody, and control and readily accessible to Aetna as TPA for the Kraft Heinz plans," the complaint said. "If it is not, then Aetna is not in compliance with its regulatory obligations. Aetna's failure to give Kraft Heinz its own standard transaction information violates Aetna's fiduciary duties."

At the time, Kraft said it was looking to be reimbursed for any losses stemming from the alleged breach in fiduciary responsibilities by Aetna, along with any profits that were made by the payer through the alleged practices. Kraft was also seeking a preliminary injunction to compel Aetna to provide complete claims data.

Lawsuits from large companies and employers have increasingly been filed against third-party health plan administrators in an effort to access complete employee medical claims data, including against Elevance Health and Blue Cross Blue Shield plans. 


Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months