The California Insurance Commissioner launched an investigation into health insurance provider Aetna after one of its former medical directors admitted under oath that he had never looked at patient records when deciding whether to approve or reject coverage, according to CNN.
The report, which CNN reported exclusively, comes after Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California between March 2012 and February 2015, said under oath that he relied on nurses’ assessments when approving insurance coverage for Aetna customers.
Aetna is the third-largest health insurance provider in the nation. It is also a Medicaid provider in Louisiana.
Iinuma’s admission came as the result of a deposition of a case in which a California man claims Aetna denied him coverage for services required to his immune disorder.
According to CNN, Iinuma was asked during the deposition if he ever looked at medical records when making coverage decisions.
“No, I did not,” the doctor is quoting as saying.
“So as part of your custom and practice in making decisions, you would rely on what the nurse had prepared for you?” asks the California man’s attorney.
“Correct,” Iinuma replied, adding that much of his work was done online except for when a nurse would call for clarification or additional information, which Iinuma said happened “zero to one” times per month.
Click here to read the full report from CNN.