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California Launches Aetna Probe After Its Top Doctor Say He Doesn’t Look at Patients’ Charts

In deposition, medical director admitted to “never” reviewing patient records while approving or denying coverage.

California’s insurance commissioner has launched an investigation into insurance giant Aetna after one of its former medical directors admitted under oath that he never looked at the medical records of patients before granting or denying coverage for health care. Jay Ken Iinuma, who was the Southern California medical director from 2012 to 2015, stunned health-care community when he disclosed his actions—or lack thereof—in a deposition about the clinical-review process as part of a lawsuit by a patient with a rare immune disorder who was denied coverage for his treatment. “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--and potentially a violation of law,” California Insurance Commissioner Dave Jones told CNN. Aetna is the third-largest health-insurance provider in the United States, covering 23.1 million people.