AETNA’S O’CARE DECEIT

Judge blasts insurer

A federal judge on Monday said insurance giant Aetna misled the US last year when it claimed to be pulling out of all but four state health exchanges because it was losing money.

In truth, Aetna exited 11 of the 15 ObamaCare state exchanges in large part as a reaction to Washington’s move to block the insurance company’s announced $37 billion merger with rival Humana, the judge ruled.

Judge John D. Bates did block the mega-merger on antitrust grounds — but took ample time in his 156-page opinion to chastise Aetna and Chief Executive Mark Bertolini for their less-than-honest actions.

“Aetna tried to leverage its participation in the exchanges for favorable treatment from [regulators] regarding the proposed merger,” Bates wrote, finding evidence to support his finding “persuasive.”

Aetna’s comments about pulling out of the ObamaCare exchanges because it was losing money became catnip for critics of the Affordable Care Act — who took to various media outlets with the insurer’s comments, waving them as Exhibit A in their battle to tear down Obama’s signature domestic initiative.

In some cases, Aetna’s comments appeared to be outright lies — and the company, the judge found, took pains to hide those circumstances.

In Florida, for example, where Aetna surprised even its state-level brass by exiting, it appears the insurer was profitable in the exchange.

On Aug. 4, Christopher Ciano, Aetna’s Florida market president, wrote Jonathan Mayhew, the head of Aetna’s ObamaCare program, saying he was “really disappointed” the company was pulling out of his state, Bates wrote.

“I just can’t make sense out of the Florida decision … Based on the latest run rate data … we are making money from the on-exchange business,” Ciano added, according to Bates.

Mayhew responded with a request to discuss via phone “instead of e-mail.”

“As Mayhew explained in court, these requests for phone calls were an attempt to avoid leaving a paper trail,” the judge wrote.

Bates also ruled that Medicare Advantage and Medicare were different markets, and the merger would create too large a player in the Medicare Advantage space.

Aetna is considering an appeal, which can take up to a year, if Humana is willing to extend the merger agreement beyond Feb. 15.

Humana is entitled to a $1 billion breakup fee.

However, President Trump’s Justice Department might choose to settle the case before the appeal is heard, the source said.

Aetna and Humana did not return calls.

Still pending is a decision on Anthem’s proposed merger with Cigna. That judge is expected to rule any day.