Insurance giant Cigna (NYSE: CI) and home health coordination company CareCentrix have been accused of a fraudulent billing scheme, in which beneficiaries were allegedly overcharged for in-home medical equipment.
Bloomfield, Connecticut-based Cigna is the fourth-largest U.S. health insurance company, according to Forbes. It contracts with other organizations that offer certain services and products to Cigna plan participants. CareCentrix—founded in 1996 by major home health provider Gentiva—is one such contracted provider, coordinating post-acute care for Cigna beneficiaries.
One of those beneficiaries has brought forth the current lawsuit, filed Oct. 6. The complaint states that the beneficiary was overcharged for medical equipment used in his home, to the financial benefit of Cigna. In one instance, he describes paying $25.68 out of pocket for a disposable filter for sleep apnea, when he should have been charged $7.50 under contracts created by Cigna and CareCentrix. The spread of $18.18 went to enrich Cigna, according to the suit.
Cigna and CareCentrix allegedly tried to disguise these overpayments through “gag clauses” in contracts with the companies providing the equipment. For instance, this type of clause would prevent J&L Medical Services, the provider of the sleep apnea filter, from disclosing to beneficiaries that charges were excessive and the money was filtering back to the insurance company.
The plaintiff is seeking class action status for the case as well as financial recompense at an amount to be proven during a requested jury trial.
Cigna does not comment on litigation matters, a spokesman told Home Health Care News. CareCentrix had not responded to requests for comment as of press time.
Written by Tim Mullaney