News Briefs: Cigna Agrees to Pay $172.3M to Resolve False Claims Act Allegations

Oct 05
Oct 05, 2023

Resolving longstanding legal issues regarding its Medicare risk adjustment submissions, The Cigna Group has agreed to pay nearly $172.3 million and enter into a Corporate Integrity Agreement with the HHS Office of Inspector General. Cigna will pay approximately $135.3 million to resolve allegations stemming from an investigation based out of the Eastern District of Pennsylvania, according to a Sept. 30 press release from the U.S. Attorney’s Office. The insurer was accused of using a “chart review” program operated to identify and submit inaccurate diagnosis information in order to receive higher risk-adjusted payments from CMS while failing to delete or withdraw the “inaccurate or untruthful” diagnosis codes. The remaining $37 million will resolve allegations related to unsupported diagnoses for MA beneficiaries arising from Cigna’s home visit program. The allegations were brought in a whistleblower lawsuit transferred from the Southern District of New York, said the U.S. Attorney’s Office. Cigna in its own press release said the agreements “fully resolve” the False Claims Act lawsuit and investigation and will allow it to “maximize the company’s focus on delivering value to customers and taxpayers.” Cigna did not admit wrongdoing as part of the settlement. Read more
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Lauren Flynn Kelly

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.