NEW YORK & NASHVILLE, Tenn. (October 18, 2022)—The United States has filed a civil health care fraud lawsuit against CIGNA CORPORATION and its subsidiary Medicare Advantage Organizations (collectively, CIGNA). The lawsuit seeks damages and penalties under the False Claims Act for CIGNA’s submissions to the government of false and invalid patient diagnosis codes to artificially inflate the payments CIGNA received for providing insurance coverage to its Medicare Advantage plan members. The government is intervening in a lawsuit filed by a whistleblower, which was originally filed in the United States District Court for the Southern District of New York and later transferred to the Middle District of Tennessee.
The government’s complaint alleges that the reported diagnoses codes were based solely on forms completed by vendors retained and paid by CIGNA to conduct in-home assessments of plan members. The health care providers (typically nurse practitioners) who conducted these home visits did not perform or order the testing or imaging that would have been necessary to reliably diagnose the serious, complex conditions reported and were prohibited by CIGNA from providing any treatment during the home visit for the medical conditions they purportedly found. The diagnoses at issue were not supported by the information documented on the form completed by the vendor and were not reported to CIGNA by any other health care provider who saw the patient during the year in which the...
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