Aetna May Expand Access to Care Under Settlement

As part of a potential settlement in a fraud and racketeering lawsuit, Aetna Inc. is "considering" expanding its members' access to "preventative health care measures," the Wall Street Journal reports. Under the plan, Aetna would "temporarily suspend" copayments for services, including annual check-ups, mammograms and childhood immunizations. The expanded access measures would be in addition to other settlement arrangements but "in lieu of cash." Plaintiffs' lawyers are seeking class action status for the case, which alleges that Aetna used "undisclosed financial incentives" to encourage providers to "limit" patients' medical care (Geyelin, Wall Street Journal, 1/22). During settlement negotiations last week, Aetna said it would "consider" stopping the use of financial incentives to "reward physicians who restrict plan members' access to health care" and agree to limit the industry practice of capitation. Aetna also would discontinue using medical guidelines that some insurers use to deny full reimbursement for care, and the insurer would provide "full disclosure" about the limits of its services to plan members, according to terms under discussion. In addition, Aetna would disclose all financial arrangements with pharmaceutical companies for price reductions. The Journal reports that negotiations between the company and the plaintiffs "could fall apart," as Aetna has just started reviewing the "feasibility of any settlement." In addition, a motion to dismiss the litigation is pending before a federal court in Miami (Wall Street Journal, 1/22).