The state of Kansas is suing Aetna over allegations that the insurer violated the Kansas False Claims Act by presenting false information about claims to a public employee health plan.
Aetna, a subsidiary of CVS Health, is one of the two health insurers acting as third-party administrators for the state's State Employee Health Plan.
The Kansas State Employee Health Plan is a self-insured health plan that administers health coverage for about 85,000 public employees and dependents in Kansas.
Aetna used an outside repricing vendor to "suppress provider reimbursements below both billed charges and the amounts withdrawn from the plan," then teamed up with the vendor to "retain a portion of the resulting 'savings' as compensation, funded directly from plan assets rather than from Aetna's administrative fee," according to a complaint Kansas filed June 24 in a state court in Shawnee County, Kansas.
In some cases, the state alleges, Aetna has been "paying itself more in administrative fees than it pays a provider of clinical services."
That "is indefensible and begs the question of whether Aetna is acting as a prudential fiduciary," the state says. "None of these...
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