News Briefs

✦ The Dept. of Justice (DOJ) on Aug. 4 filed a complaint-in-intervention in the U.S. District Court for the Southern District of New York, alleging that Cigna Corp. and its affiliates submitted false and fraudulent risk adjustment claims to CMS resulting in overpayments of more than $1.4 billion. The suit, U.S. ex rel. Robert A. Cutler v. Cigna Corp (7:17-cv-07515-KMK), details an enhanced wellness visit program, known as the “360 Program,” that Cigna-HealthSpring allegedly used to identify health conditions that could raise the risk scores of Medicare Advantage plan members and therefore increase plan payments. The complaint was originally brought by an officer of Texas Health Management, a service provider of Cigna-HealthSpring between 2012 and 2017. Cigna in its latest 10Q filing with the U.S. Securities and Exchange Commission pointed out that the DOJ is conducting an “industry-wide investigation” of MAOs’ risk adjustment practices and said it “will continue to cooperate with the DOJ’s investigation.” The DOJ earlier this year filed a similar suit against Anthem, Inc. Visit https://bit.ly/31ldaNM.

✦ After significantly expanding its presence in Northern California this year, Medicare Advantage insurer Alignment Healthcare plans to enter several new markets across California, Nevada and North Carolina next year. Pending regulatory approval, the product expansion would enable Alignment to reach more than 5.9 million Medicare- eligible beneficiaries, according to an Aug. 6 press release. Also pending approval, the insurer plans to introduce several new products in October, “most notably a signature virtual health plan to provide seniors a safe, convenient and personalized virtual care option.” Contact Priya Shah at priya@mpublicrelations.com.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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