A Kraft Heinz Co. employee benefits group representing employees, retirees and their dependents is suing Aetna for allegedly breaching its fiduciary duties and using its role as third-party claims administrator "to enrich itself to Kraft Heinz's detriment."
According to the June 30 complaint filed in a Texas district court, Aetna has allegedly 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 only applied to 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."
Kraft said it is 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 is also seeking a preliminary injunction to compel Aetna to provide complete claims data.
Becker's has reached out to Aetna for comment and will update this article if more information becomes available.