Whistleblower Claims Cigna Defrauded Medicare For Billions

In a recently unsealed lawsuit, a whistleblower alleges that the health care insurer Cigna engaged in a scheme to submit invalid diagnostic codes. The whistleblower, an attorney, claims that Cigna, through a subsidiary, “received billions in overpayments from the federal government” in a scheme involving the insurer’s Medicare Advantage plans. The suit was filed under the federal False Claims Act. It alleges that “Cigna-HealthSpring has knowingly defrauded the United States through an intentional and systematic pattern and practice of submitting to CMS invalid diagnosis codes derived from in-home health assessments.” It claims this took place “from at least 2012 until at least 2017,” and likely thereafter. The whistleblower filed the lawsuit under seal in 2017, in the US District Court for the Southern District of New York. An amended version was unsealed in August. Cigna denies the allegations. “We are proud of our industry-leading Medicare Advantage program and the manner in which we conduct our business,” the insurer stated. “We will vigorously defend Cigna against all unjustified allegations.”