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October 3, 2023

Cigna settles False Claims Act lawsuit for $172M

Photo | CoStar Cigna headquarters in Bloomfield.

Health insurer The Cigna Group said it has settled a lawsuit brought by the federal government that alleged violations of the False Claims Act.

The Bloomfield-based company will pay about $172 million to resolve the legal claims about certain past Medicare Advantage risk adjustment practices.

According to the Department of Justice, Cigna submitted and failed to withdraw “inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare.” 

Since the alleged violations occurred, Cigna said it has completed a successful program audit conducted by the Centers for Medicare & Medicaid Services.

"These agreements fully resolve long-running legal matters, enabling us to focus our resources on all those we serve and avoiding the uncertainty and further expense of protracted litigation," said Chris DeRosa, president of Cigna Healthcare's U.S. government business. "We are pleased to move beyond industry-wide legal disputes related to past risk adjustment practices, and we look forward to continuing to provide high-quality, affordable Medicare Advantage coverage to our customers and delivering value to the taxpayers in the years ahead."

As part of the settlement, Cigna will enter into an agreement with the Office of Inspector General of the U.S. Department of Health and Human Services to promote ongoing compliance over a five-year period.

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