The clinician called a prospective customer who was applying for health insurance to pose a very direct question: Why had she left the names of several medications she was taking off the application she submitted to Aetna? The clinician rattled off the names of the drugs, the dates they were prescribed, and the doctors who had prescribed them.
The woman insisted the information was wrong. She recounted the story to her mom, looking for advice. The mother was shocked and embarrassed. Those prescriptions were hers, designed to treat medical conditions she'd been hiding from her daughter. The secret was out, and the women were forced into an emotional conversation about the mother's ongoing struggles with her health.
The mother eventually filed a complaint with the U.S. Department of Health and Human Services, alleging that Aetna had violated her privacy. A government investigation uncovered the cause of the error: The women's medical records had been mixed up in a database maintained by a supplier to the second-largest U.S. health insurance company. Bloomberg obtained a copy of the HHS investigation, along with nearly a dozen other cases, through a public information request. The details offer a rare look at how the health-care industry's growing reliance on data mining can go awry.
Aetna blamed the mistake on Milliman, a data supplier. In its explanation to the government, Aetna said Milliman described the inaccurate linking of medications as a "very infrequent occurrence" that sometimes happens when pharmacies make mistakes in coding. Jeremy Engdahl-Johnson, a spokesman for Milliman, declined to comment, citing "a longstanding policy not to comment on our work for clients."
Aetna says it no longer uses Milliman's IntelliScript data service or other prescription information for determining an individual's eligibility for insurance, a practice phased out across the health insurance industry as part of President Barack Obama's health-care overhaul. Aetna says the company does use prescription databases for setting group rates and assessing risk.
Government documents show that Aetna hired RSA Medical to call patients about discrepancies between IntelliScript results and what patients had disclosed in their applications. The RSA Medical representative who called the daughter did not know or disclose that the medications belonged to the applicant's mother. RSA Medical says it complies with all privacy laws.
Aetna told HHS that the mother and daughter figured out the link on their own. For this reason, the HHS investigation concluded that no privacy rule was broken. In addition, Aetna and Milliman had a business associate agreement that allowed them to share data on applicants, HHS said. HHS's Office for Civil Rights closed the Aetna case without finding any wrongdoing.
Medical data is legally shared with more third parties than many Americans realize, said Ifeoma Ajunwa, an assistant professor of law at the University of the District of Columbia. Sensitive information about a patient's prescriptions and conditions can bounce from one company to the next as part of routine billing or administrative processes. "A major concern with prescription databases is that they provide ample opportunities for invasions of privacy," Ajunwa said. They are also prone to mistakes.