Did Cigna Deserve its $172M Penalty?
By Admin | October 15, 2023
After Cigna agreed to pay $172 million to resolve allegations that it violated the False Claims Act in its Medicare Advantage plans, it begs this question: Is the insurer deserving of this penalty? One industry expert believes this is only a small part of what MA plans owe in penalties to CMS, while another believes there needs to be more clarity from the government.
CMS pays MA plans a fixed monthly amount for each beneficiary enrolled in their plans, and then adjusts those payments based on “risk” factors that affect the member’s health expenditures. This makes sure that MA plans receive more payment for members who have higher healthcare costs and less payment for those who have lower healthcare costs. CMS makes these adjustments by collecting risk adjustment data, which includes medical diagnosis codes from MA plans.
The federal government alleges that Cigna “submitted inaccurate and untruthful patient diagnosis data to CMS in order to inflate the payments it received from CMS, failed to withdraw the inaccurate and untruthful diagnosis data and repay CMS, and falsely certified in writing to CMS that the data was accurate and truthful.” The $172 million settlement, announced Saturday, resolved these allegations and the insurer admitted to...(More)
For more info please read, Did Cigna Deserve its $172M Penalty?, by MedCityNews
