Jones said in statement, “If a health insurer is making decisions to deny coverage without a physician ever reviewing medical records, that is a significant concern and could be a violation of the law.”

But in a statement released Wednesday morning, Hartford, Connecticut-based Aetna said that medical records were, in fact, an integral part of the clinical review process during Iinuma's tenure at the company, and that the statement used in the CNN report was taken out of context.

“Aetna medical directors review all necessary available medical information for cases that they are asked to evaluate,” according to the statement. “That is how they are trained, as physicians and as Aetna employees. In fact, adherence to those guidelines, which are based on health outcomes and not financial considerations, is an integral part of their yearly review process. As Dr. Iinuma stated in his deposition, his evaluation 'was to ensure care was being provided in a safe and effective manner.'”

Aetna also said the physician made a sworn statement on Feb. 13, after the story appeared that, “in addition to reviewing the relevant portions of submitted medical records, it was also generally my practice to review Aetna nurses' summaries, notes, and the applicable Aetna clinical policy bulletins. After reviewing the relevant, submitted portions of the medical record, the nurse's notes, and the clinical policy bulletin(s), I would apply my medical training, experience, and judgment to reach an appropriate coverage determination.” The insurer released the physician's redacted statement along with its own.

An attempt to reach the physician by phone Wednesday was unsuccessful.

The increased scrutiny comes amid Woonsocket, Rhode Island-based CVS's plan to purchase Aetna for about $69 million. That proposed merger currently is under review by the U.S. Department of Justice.

Andre Barlow, an antitrust lawyer at Washington's Doyle, Barlow & Mazard, said despite the state regulators' inquiries, the merger likely is in no jeopardy. “It is always concerning when some past conduct by a target [acquired company] is uncovered during the merger review process, but typically these issues do not derail a deal,” he said. “In some cases, the buyer may already know about the issue, and it has been disclosed.”

State regulators are important in any review of a merger, Barlow said. And unlike federal regulators, who are concerned with harm to competition, state regulators use a broader standard—whether a merger is in the public interest, he added. Thus, they could consider a number of factors, including local competition and the companies' financial condition, and use these investigations to obtain broader concessions than the DOJ Antitrust Division could.

“There may be things that will come out of this investigation that relate to certain conduct-type remedies that are unrelated to what the Antitrust Division would sign off on,” he said.

While mere announcements of increased scrutiny into Aetna's claims approval and appeals processes may not in and of themselves threaten the planned merger, sufficiently adverse results from them could give CVS an out, if the company were interested in one, said Shannon Zollo, corporate partner at Boston-based law firm Morse, Barnes-Brown & Pendleton.

“Let's just say that if the states concluded that bad things had been occurring and imposed some type of fine or restrictions, the buyer can take the position that they can walk away,” he said. “But if the buyer doesn't want to walk away, it may use [those adverse developments] to re-leverage conditions or terms.”