DOJ sues Cigna alleging Medicare Advantage fraud

October 17, 2022


The Justice Department has sued Cigna for allegedly collecting tens of millions of dollars in excess Medicare payments by exaggerating its members’ illnesses.

The U.S. Attorney for the Southern District of New York sued Cigna on Friday in the U.S. District Court for the Middle District of Tennessee and alleges Cigna violated the False Claims Act by reporting its Medicare Advantage members were sicker than they were. The lawsuit alleges that from 2012 to 2019, Cigna hired health professionals to visit patients’ homes and falsely document medical conditions to increase the revenue it generated from taxpayers.

The Justice Department announced it planned to intervene in an ongoing whistleblower lawsuit regarding Cigna’s Medicare Advantage operations in August. Many, but not all, of the allegations in the Justice Department’s lawsuit mirror those from the whistleblower case, which was filed in 2017 in the U.S. District Court for the Southern District of New York. The whistleblower alleges that Cigna improperly billed the federal government by $1.4 billion. Federal prosecutors allege the insurer overcharged the Centers for Medicare and Medicaid Services by “tens of millions” of dollars.

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