A recently unsealed whistleblower lawsuit out of Philadelphia accuses Aetna of assigning children under Medicaid to providers who were dead, out of state or did not specialize in pediatrics.
The result was "tens of thousands" of children allegedly assigned to providers who were not contracted with Aetna and some who were assigned to gynecologists and vascular surgeons, The Philadelphia Inquirer reported Nov. 10.
According to the lawsuit, Aetna supervisors asked whistleblower Carol Wessner, RN, — a quality management consultant at the time — to stop reporting their findings on the payer's Philadelphia Medicaid program.
While acting U.S. Attorney for the Western District of Pennsylvania Stephen Kaufman opted to not intervene in the case, he said the suit would require written consent from the court and U.S. attorney general for its dismissal, the Inquirer reported.
An Aetna spokesperson told Becker's that it stands by its quality and network and will defend itself against allegations.
"The plaintiff's allegation that we have network adequacy deficiencies across the country is irresponsible and unrelated to the DOJ's investigation," the spokesperson told Becker's. "We deny the allegations in the complaint, and intend to vigorously defend ourselves should the plaintiff choose to move forward with it. We're pleased that following our complete cooperation with the DOJ and after reviewing all of the evidence, the government chose not to participate in the lawsuit."