Cigna falsified the health conditions of its Medicare Advantage plan members to coax CMS into making larger payments to the insurer on behalf of beneficiaries, a U.S. Justice Department lawsuit alleges. Cigna did not respond to a request for comment.
- Cigna used a medical assessment it called “360” to find health conditions that could raise risk scores of plan members, offering incentives to physicians who gave the exam and using third-party contract providers to perform them in plan member homes, according to the lawsuit.
- CMS overpaid Cigna an estimated $1.4 billion from 2012 to 2017 and DOJ is seeking equal to three times that amount in damages, along with a civil penalty of $11,000 for each violation.
Source: Healthcare Dive