The Cigna Group will pay $172.3 million to resolve allegations that it violated the False Claims Act by submitting incorrect Medicare Advantage patient data to CMS in order to receive higher payments from the agency.
The U.S. Attorney's Office for the Eastern District of Pennsylvania alleged Sept. 30 that Cigna also falsely certified that the submitted data was accurate, failed to withdraw the "untruthful" data and did not repay CMS.
For payment years 2014 to 2019, the DOJ alleges that Cigna did not verify the accuracy of diagnosis codes reported by providers before submitting to CMS, and reviewed charts to identify where it could receive additional payments from CMS.
For payment years 2016 to 2021, the government alleges Cigna purposefully submitted and failed to withdraw inaccurate codes for morbid obesity specifically.
Cigna will use $135.3 million from the settlement to resolve the allegations from the Justice Department. The remaining $37 million resolves allegations related to unsupported diagnoses for Medicare Advantage enrollees that received in-home services from Cigna.
As part of the settlement, Cigna has entered into a five-year accountability and auditing agreement with HHS' Office of Inspector General, which will require company executives and board members to certify Cigna's compliance moving forward. The payer must also conduct annual risk assessments and submit to independent risk adjustment audits.
"These agreements fully resolve long-running legal...
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