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Violation Tracker Individual Record

Company: Aetna Health, Inc.
Current Parent Company: CVS Health
Penalty: $9,457,500
Year: 2007
Date: July 23, 2007
Offense Group: consumer-protection-related offenses
Primary Offense: insurance violation
Violation Description: As a result of provider complaints, the Department learned that starting in or about June 2007, Aetna paid certain out-of-network claims at a rate based on 125% of Medicare (75% of Medicare in the case of lab fees and durable medical equipment). Aetna sent certain providers a letter stating the payment represented Aetna's determination of a fair payment and that additional reimbursement would not be considered. Aetna applied this claims practice for services such as emergency care, services provided by nonparticipating providers during an admission to a network hospital, and services rendered as the result of a referral or authorization by Aetna. In such cases, Aetna knew that its payment obligations exceeded what it paid and represented in its letters. Aetna stated that a total of 130 providers were issued such a letter, with the first issued on or about June 8, 2007.
Level of Government: state
Action Type: agency action
Agency: New Jersey Department of Banking & Insurance
Civil or Criminal Case: civil
Facility State: New Jersey
HQ Country of Current Parent: USA
HQ State of Current Parent: Rhode Island
Ownership Structure of Current Parent: publicly traded
Major Industry of Current Parent: retailing
Specific Industry of Current Parent: retail-pharmacies
Source of Data: (click here)
Source Notes: If an online information source is not working, check the Violation Tracker Data Sources page for an updated link.
Current parent company note: Parent-subsidiary relationship is current as of the most recent revision listed in the Update Log.