Aetna/CVS has a long and colorful history of retaliation. Managed by insecure dimwits, they consider transparency and constructive advice to be “rude”. Did you know that 4 years ago, almost to the day, management was advised that claims fraud was out of control? Aetna paid millions of dollars to an immigrant who claimed to be performing sophisticated spinal surgery in his office and through an 18 gauge needle. The offender has a picture of a spinal implant on his website. When the Aetna Medical Director told the offender that no payment would be sent because of fraud, he erupted. Aetna promptly retaliated against the Medical Director. Here is the exact statement,” you could pay every claim without scrutiny or delay if you rejected the fraudulent claims.” Sound familiar? The Marine who detained a shoplifter until law enforcement arrived - Fired. Did you know that there is a Criminal Anti-Retaliation Statute for those who create monopolies and engage in retaliation? Management needs to be held accountable.
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So you telling me the creation of the"Payment Integrity Center of Excellence" is a joke?
OP, why didn't you just say Aetna paid a doctor who claimed to be performing sophisticated spinal surgery in his office, instead of saying "an immigrant who claimed to be performing sophisticated spinal surgery in his office" ? Why was THAT relevant?
Did the medical director report it to SIU?
I reported two years ago and a certain health plan going against state regulations to SIU, to ethics line, to my bosses boss, to the regional VP, to the interim COO, to the LD Network management, to the LD Informatics, to anyone who would care to hear me out. They don't care. They're in the business of shoving claims through right or wrong, and bolstering their network. Because the truth is they are there to pick-up a check and that's it. Pro quro.
If only we lived in a country with labor laws, where employees could not be arbitrarily fired and their health insurance benefits summarily terminated.