Prosecutors alleged that Cigna submitted inaccurate and bogus codes for Medicare Advantage plans between 2016 and 2021.
Health insurance giant Cigna will pay more than $172 million to settle federal claims that it knowingly submitted false diagnosis codes under the federal Medicare Advantage program.last year that Cigna submitted inaccurate and untruthful codes for Medicare Advantage between 2016 and 2021. The U.S. Department of Justice said in a "Cigna knew that these diagnoses would increase its Medicare Advantage payments by making its plan members appear sicker," said Damian Williams, U.S.
In one example, federal prosecutors said Cigna submitted reimbursement documents for patients who are morbidly obese but did not submit medical records that showed their body mass index being above 35, which is a requirement for that particular diagnosis code. Cigna said the settlement with the government resolves a long-running legal case and"avoided the uncertainty and further expense" of a drawn-out legal battle. Cigna also said it will enter a corporate-integrity agreement for five years with the Department of Health and Human Services' inspector general office. That deal is designed to promote compliance with federal health program requirements.
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