Fraudulent Health Insurance Costs

• Motley Rice, with co-counsel, has filed litigation against global insurance provider Cigna Health & Life Insurance Co., alleging that the company violated its own plans by fraudulently inflating copayments, coinsurance, deductibles and other costs for home-patient services and products provided through its partnership with CareCentrix Inc. A recently-filed amended complaint further alleges a similar scheme involving clinical laboratories.
• Our firm is also investigating whether other insurance companies are engaged in billing fraud, including Aetna Health Inc., Humana Inc., UnitedHealth Group Inc. and other insurance companies.

The alleged insurance fraud scheme

Seeking treatment for sleep apnea, a Motley Rice client alleges he was charged a $25.68 deductible for a disposable filter from J&L Medical Services, one of more than 9,000 CareCentrix approved home care and service providers. Unbeknownst to the plaintiff, however, J&L contracted with Cigna and CareCentrix to provide the device for only $7.50. Cigna allegedly took advantage by pocketing the difference.

Another Motley Rice client alleges that Cigna billed her more than $2,000 for a blood test. Cigna told her that the laboratory had charged it over $17,000—and, thus, that Cigna actually had saved her thousands of dollars—but the actual cost of the test was only about $450.

Similarly affected patients may have been overcharged for multiple services and products, including:

• Laboratory tests
• Breathing tubes
• CPAP equipment
• Medical beds
• Monitoring equipment
• Occupational therapy
• Skilled nursing care
• Wheelchairs