Aetna, an Ohio Medicaid contractor, accused of denying kids care in Pennsylvania

In a case that could have implications for Ohio, a Pennsylvania whistleblower is accusing Aetna of making it impossible for the parents of some kids on Medicaid to find doctors. The insurer then pocketed money from the state for services not rendered, the suit alleges.

Aetna denies the charges.

The case is relevant here because the Ohio Department of Medicaid in April awarded a $1 billion contract to Aetna to implement OhioRISE, an ambitious new program meant to coordinate care for 60,000 children with complex behavioral needs.

The Pennsylvania allegations, which were unsealed last month in federal court in Pittsburgh, might cast doubt on whether the company will live up to its promises in the OhioRISE program.

The allegations also add to questions of conflict and bias concerning Ohio’s procurement this year of the OhioRISE contract and six others for $22 billion worth of Medicaid managed care. Together, the contracts are meant to reshape the way the Ohio Medicaid department delivers care to 3 million people.

Read more: https://ohiocapitaljournal.com/2021/10/27/aetna-an-ohio-medicaid-contractor-accused-of-denying-kids-care-in-pennsylvania/