Federal prosecutors alleged that Cigna submitted inaccurate codes to Medicare Advantage from 2016 to 2021.
“Cigna knew that these diagnoses would increase its Medicare Advantage payments by making its plan members appear sicker,” Damian Williams, U.S. attorney for the Southern District of New York, told CBS. “The reported diagnoses of serious and complex conditions were based solely on cursory in-home assessments by providers who did not perform necessary diagnostic testing and imaging.”
Cigna promised to enter a corporate integrity agreement for five years with HHS’ Office of Inspector General.
A recent audit on another major insurer, Aetna, estimates that the payer received at least $25.5 million in overpayments in a one-year period.
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