DOJ orders Cigna to pay $172M over false claims to Medicare

Multinational health insurance company Cigna agreed to pay more than $172 million as part of a settlement with the Department of Justice (DOJ) addressing allegations it submitted and failed to withdraw false claims to Medicare.

Cigna submitted inaccurate or untruthful diagnosis codes related to various risk factors like obesity, the DOJ announced in a press release Saturday. The company reported diagnosis codes based on forms completed by vendors retained and paid by Cigna to conduct in-home assessments, the agency said. In some cases, in-home healthcare providers could not reliably diagnose patients and were prohibited from providing treatment by Cigna for medical conditions they purportedly found, the DOJ alleged.

The settlement resolved a lawsuit brought under the qui tam provisions of the False Claims Act by Robert Cutler, a former part-owner of a vendor retained by Cigna to conduct home visits. He will receive more than $8.1 million.