California Insurance Commissioner Dave Jones announced that his office has launched an investigation into health insurance provider Aetna (AET) after a former medical director admitted under oath that he never looked at patient records when deciding to approve or deny care.
Dr. Jay Ken Iinuma, the former employee, is now also under investigation by Jones' office.
"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," Jones told CNN.
Iinuma's testimony was part of a lawsuit against Aetna that was filed by a college student who claimed a breach of contract and bad faith after he was denied coverage for an infusion of intravenous immunoglobin for an immune disorder from which he suffers.
Iinuma said that he was simply following the training procedures that were provided by Aetna where nurses reviewed the records and gave him recommendations.
Aetna for its part has defended Iinuma's process, saying that it "look(s) forward to explaining our clinical review process."