Bob
Herman August 5, 2020
The Department of Justice is suing Cigna,
alleging the health insurance company fraudulently mischaracterized the health
of its Medicare Advantage enrollees as a way to receive higher federal
payments.
The bottom line: This lawsuit comes months after
the DOJ sued Anthem over
similar allegations, highlighting the federal government's aggressive stance
toward resolving long-standing medical coding issues within
Medicare Advantage plans.
Driving the news: The DOJ's lawsuit against
Cigna, which stemmed from a whistleblower who worked at a company that worked
with Cigna, said the insurer created a health assessment for its Medicare
Advantage members called a "360."
·
These 360 reviews were
used as a means to record "false health conditions" for patients, and
Cigna also allegedly paid bonuses to doctors to complete a certain number of
these reviews.
·
Cigna did not
immediately respond to questions for comment.
Flashback: Cigna's Medicare Advantage program was sanctioned in 2016
after the federal government found Cigna inappropriately denied care to its
members.
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