Class Action Cigna Lawsuit Alleges Health Insurance Fraud

A resident of Washington State recently filed a class action Cigna lawsuit against Cigna Corporation, alleging that the company committed health insurance fraud.

According to the Cigna lawsuit, the plaintiff, Daniel Perry was forced to pay heavily inflated copayments for prescriptions that were medically necessary and should have been fully covered by insurance.

Indeed, the Cigna lawsuit alleges that Cigna Corporation enacted a fraudulent copayment clawback scheme intended to wring as much money as possible from its users.

While people with health insurance are generally aware that they will be required to pay a certain copayment on even those medications for which they are fully covered, they generally assume that the copayment amount will be a small portion of the drug’s expense.

However, according to the Cigna lawsuit, consumers with Cigna health insurance were forced to pay artificially inflated copayment prices that, in some cases, amounted to either the full price of the drug or even more than the drug’s cost, even though the medically necessary drug itself is covered by insurance.

Cigna used this fraudulent scheme, the Cigna lawsuit alleges, in order to claw back (recoup) a large portion of the plaintiff’s copayment amount.

Clawback fees are enacted with a health insurance company like Cigna requires pharmacies to charge consumers a co-pay for a drug that could be purchased for less money without insurance. The difference between the higher copayment cost and the actual cost of the drug is “clawed back” to the insurance company as additional profit padding.

Perry filled prescriptions for a medically necessary drug covered by his insurance on March 4 and April 6, 2016. Perry was required to pay a $6.99 copay in each instance. However, this copayment amount had been artificially inflated, leaving Cigna to claw back around $3.65 of each copayment from the pharmacy.

This was not the first time that this claw back scheme had affected the plaintiff. Previously, on July 18 and August 14, 2015, Perry had filled prescriptions for a drug requiring a $7.15 copayment, which had allegedly been inflated to provide Cigna with a $3.81 clawback of the copayment amount.

The Cigna lawsuit was filed in November 2016 on multiple counts, including but not limited to violation of RICO, fraud, negligent misrepresentation, and breach of fiduciary duty.

Health Insurance Clawback Lawsuits

Lawsuits like this Cigna lawsuit allege that insurance companies are overcharging services or medications, and in some cases wrongfully deny coverage to those they insure.

In some cases of health insurance clawbacks, companies purposely require pharmacies to charge exorbitantly inflated copayment amounts of consumers that can be more than ten times what they would have been charged without insurance.

A number of health insurance companies, including Cigna, may be involved in health insurance fraud clawback fees.

If you or someone you love was overcharged for a prescription drug or otherwise targeted with health insurance fraud, you may be able to file a lawsuit.

The Cigna Lawsuit is Perry v. Cigna Corporation, et al., Case No. 3:16-cv-01904, in the U.S. District Court for the District of Connecticut.