Attorneys for the government said that Cigna submitted fake, yet serious diagnoses so that it could claim larger reimbursements from Medicare. It also alleges that the insurer knowingly submitted false certifications every year, claiming that its diagnosis submissions were “accurate, complete, and truthful.”
Whistleblower and complainant, Robert A. Cutler, an employee of Cigna contractor Texas Health Management LLC, filed a False Claims Act in 2017, but the case remained under seal until it was made public in August 2020.
The government’s complaint comes two years later. In the complaint, Cutler detailed one instance of billing codes that were being added for chronic obstructive pulmonary disease and dementia, even though a nurse reported that the patients had no such conditions.
Cutler also claimed that Cigna trained its contractors to make fake diagnoses for rheumatoid arthritis based only on weight loss, fatigue, or symptoms of stiffness or pain. The complaint says that the government was “unaware that these claims were false and fraudulent,” and it “overpaid Cigna by more than $1.4 billion.”
