Op risk data: Cigna catches a $172m cold over fake diagnoses

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Credit: Askar Karimullin/Alamy Stock Photo

September’s largest loss is a $172.3 million fine on insurer Cigna by the US Department of Justice (DoJ). The regulator said that Cigna had submitted false patient diagnoses to defraud a federal Medicare programme.

Between January 1, 2012, and December 31, 2019, Cigna knowingly submitted false and invalid diagnoses of serious, complex medical conditions to the Centers for Medicare & Medicaid Services for risk adjustment purposes. The diagnoses were variously based only on third-party

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