Health insurance company Cigna has agreed to pay over $172 million to settle federal allegations that it knowingly submitted false diagnosis codes under the Medicare Advantage program. The U.S. Department of Justice had accused Cigna of submitting inaccurate and untruthful codes for Medicare Advantage between 2016 and 2021. The company allegedly failed to delete or withdraw incorrect codes, which inflated its Medicare Advantage payments by making its plan members appear sicker than they were. The reported diagnoses were based on superficial in-home assessments without necessary diagnostic testing.
Cigna stated that the settlement resolves a long-standing legal case and will also enter a five-year corporate-integrity agreement with the Department of Health and Human Services’ inspector general office. This comes as Cigna faces a class-action lawsuit accusing it of using an algorithm to deny certain medical claims.