The government claims that “Cigna knew that, under the Medicare Advantage reimbursement system, it would be paid more if its plan members appeared to be sicker.” The government contends that Cigna knowingly submitted diagnosis codes for serious and chronic medical conditions based on home visits by health care professionals who failed to actually perform any testing to reliably provide such a diagnosis with those types of complex conditions being reported.
The complaint further alleges that Cigna prohibited its health care providers from providing any treatment during the home visit for the medical conditions they supposedly discovered. The government also pointed out that none of the Patients’ other physicians who treated them at other times, ever reported the ailments that Cigna allegedly found.
The government is represented by Damian Williams and Peter Aronoff of the U.S. Attorney’s Office for the Southern District of New York and Mark H. Wildasin and Kara F. Sweet of the U.S. Attorney’s Office for the Middle District of Tennessee.
