Whistleblower Lawsuit Claims Aetna Better Health Of Pennsylvania Misrepresented Its Pediatric Network To Secure Medicaid Contracts

A recently unsealed whistleblower lawsuit filed in 2017 claims that Aetna Better Health of Pennsylvania misrepresented its pediatric provider organization network in Pennsylvania in its bids in 2010 and 2014 for Medicaid HealthChoices contracts with the state. The relator, a former care management nurse for the plan, alleges that Aetna members were assigned to primary care physicians who were presented as being in network, but who did not participate, were located out of state, or who did not usually treat children. Aetna serves about 180,000 Pennsylvania Medicaid members, about half are children.

In the complaint, the relator said that . . .