Aetna trial day 8: what you need to know

December 15, 2016

  •  The witnesses for today were Mr. James Paprocki (works for Aetna), Leslie Carolina Kirk Koffman (sales manager for Humana in Kentucky), Cynthia Fulmer (works for Aetna, has responsibility for the Deep South and mid-South markets), Jeff Fernandez (Vice President of Humana's Western Segment) and Dr. J. Mario Molina (President and CEO of Molina).   

  • The defense argued that competition was very robust in Medicare Advantage (MA) markets, that a variety of seniors chose MA for a variety of reasons, and that Molina was well equipped to take over the divested assets and preserve competitive markets. 

  • Mr. Paprocki answered defense questions by saying that CMS exercised substantial oversight, including the MLR, meaningful difference test, margin requirements, and other rules. However, DOJ did an excellent job of pointing out flaws in his claim; MLR is not part of the MA bid process and applies at the contract level, not for all individual plans. 

  • The two saleswomen testified that MA and MedSupp plans were sold to all kinds of seniors, including those with high and low incomes, and that the MA markets were quite competitive, especially in Georgia. DOJ managed to get an admission that Humana was a strong opponent and that Molina was not present in Georgia MA markets. 

  • Jeff Fernandez was well-spoken but often non-responsive to DOJ's questions. He argued that the MA market in Texas was constantly changing, providers were getting more competitive, and that Humana cared about its consumers so it wouldn't unduly raise premiums. DOJ countered that only 6% of Texas MA markets had seen entry over the last few years, and that he didn't mention many firms that exited the markets. 

  • Dr. J. Mario Molina testified that Molina was not just a Medicaid company, as DOJ said. He argued that it had $16 billion in annual revenues and 4.3 million members, and had been in the Medicare marketplace for years. "We are not a trivial participant in anything." He appeared more confident and knowledgable than his brother did. 

 

Please reload

Featured Posts

United States-Mexico-Canada Agreement (USMCA)

October 5, 2018

1/4
Please reload

Recent Posts
Please reload

Archive
Please reload

Search By Tags
Please reload

Follow Us
  • Facebook Basic Square
  • Twitter Basic Square
  • Google+ Basic Square