The Department of Justice has filed a civil lawsuit against Cigna and its Medicare Advantage subsidiaries alleging that it sought to boost its reimbursement by submitting false and inaccurate Medicare Advantage diagnostic codes, Healthcare Finance reports.
The lawsuit seeks damages and penalties under the False Claims Act for the submissions, which the DOJ claims was used to artificially inflate the payments Cigna received for its MA coverage. The government is intervening in a lawsuit initially 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.
Specifically, the 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 healthcare providers who conducted these home visits – nurse practitioners, typically – did not perform or order the testing or imaging that would have been necessary to reliably diagnose the serious, complex conditions reported, the DOJ said. The providers were also allegedly prohibited by Cigna from providing any treatment during the home visit for the medical conditions they purportedly found. Read more.
