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Prosecutors said Cigna obtained tens of millions of dollars in Medicare funds by submitting false diagnoses for patients in cases where providers retained by the company had not conducted the necessary tests.
“Cigna knew that, under the Medicare Advantage reimbursement system, it would be paid more if its plan members appeared to be sicker,” Damian Williams, the top federal prosecutor in Manhattan, said in a statement.
Medicare Advantage is a program in which private insurers provide coverage to patients who opt out of the traditional Medicare program, a U.S. government-run health plan for seniors.
