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  • Writer's pictureShelly Asbury

Correct and Accurate Billing

๐Ÿ“ข ๐Ÿ›‘ One of the services we offer to consumers of healthcare (you, the patient) is medical record reviews for correct and accurate coding/billing. This is one of the reasons why:


Cigna Pays Over $172 Million to Settle Whistleblower FCA Allegations and $37 Million to Settle Fraud Allegations

Cigna submitted inaccurate and untruthful patient diagnosis data to CMS

After investigation, Cigna did not substantiate some diagnosis codes that were reported by providers and previously submitted by Cigna to CMS related to Medicare Advantage (MA) plans and various risk factors based on diagnosis code .

Cigna is paying $172,294,350 and entered into a 5-year Corporate Integrity Agreement (CIA) to resolve allegations that it violated the False Claims Act by submitting and failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare.

Cignaโ€™s Faulty Chart Reviews

Cigna retained diagnosis coders to review medical records or โ€œchartsโ€ to identify all medical conditions supported and to assign the beneficiaries diagnosis codes for those conditions. Cigna relied on the results of those chart reviews to obtain additional payments from CMS. Also, the chart reviews did not substantiate some diagnosis codes that were reported by providers and previously submitted by Cigna to CMS.

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