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California Launches Investigation of Aetna

California Insurance Commissioner Dave Jones has launched an investigation into Aetna after learning that a former medical director for Aetna in Southern California, Dr. Jay Ken Iinuma, admitted under oath that he never looked at patients’ records when deciding whether to approve or deny care...
February 13, 2018

California Insurance Commissioner Dave Jones has launched an investigation into Aetna after learning that a former medical director for Aetna in Southern California, Dr. Jay Ken Iinuma, admitted under oath that he never looked at patients’ records when deciding whether to approve or deny care.

The investigation centers on Iinuma’s deposition as part of a lawsuit filed against the insurer by a college student who claims he was denied coverage for a treatment for his rare immune disorder. During the deposition, Iinuma said he followed Aetna's training, in which nurses reviewed records and made recommendations to him.

“If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — potentially a violation of law,” said Jones.

Members of the medical community expressed shock, saying Iinuma’s deposition leads to questions about Aetna’s practices across the country. “Oh my God. Are you serious? That is incredible,” said Dr. Anne-Marie Irani, professor of pediatrics and internal medicine at the Children’s Hospital of Richmond at VCU. “This is potentially a huge, huge story and quite frankly may reshape how insurance functions,” said Dr. Andrew Murphy, a fellow of the American Academy of Allergy, Asthma and Immunology. Aetna defended Iinuma, who is no longer with the company, saying in its legal brief that he relied on his “years of experience” as a trained physician in making his decision about Washington’s treatment and that he was following Aetna’s Clinical Policy Bulletin appropriately.


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