Cigna agreed Saturday to pay slightly more than $172 million to settle a claim by the government that it submitted false health data to Medicare in order to increase payments it received for patients enrolled in its Medicare Advantage programs, the justice department said.
Cigna owns and operates businesses that offer Medicare Advantage plans across the country.
The federal government claimed that the company submitted “inaccurate and untruthful” patient diagnosis data to Medicare in order to inflate the payments it received, that it failed to withdraw the inaccurate diagnosis data and repay Medicare, and falsely certified in writing that the data was truthful.
“Over half of our nation’s Medicare beneficiaries are now enrolled in Medicare Advantage plans, and the government pays private insurers over $450 billion each year to provide for their care,” Deputy Assistant Attorney General Michael D. Granston said when announcing the settlement. “We will hold accountable those insurers who knowingly seek inflated Medicare payments by manipulating beneficiary diagnoses or any other applicable requirements.”
Under the government Medicare Advantage Program, also known as Medicare Part C, beneficiaries can obtain their Medicare-covered benefits through private insurance plans known as Medicare Advantage plans.
Medicare pays the advantage plans a fixed monthly amount for each beneficiary who enrolls. It adjusts the payments so that plan operators are paid more for high risk patients...
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