Cigna Faces Growing Legal Lawsuits Following Claims of Automated Denials

Cigna Group is grappling with a surge in lawsuits from both members and shareholders after a ProPublica report alleged the denial of members' claims en masse without individual evaluation, thereby withholding coverage for certain services.

The report by ProPublica in March pointed out potential violations by Cigna concerning state laws, suggesting that the company's medical directors denied a considerable volume of claims without scrutinising individual members' records. This was facilitated by an automated claims review process named PxDx. 

The report disclosed that Cigna physicians denied over 300,000 claims in a mere two months during 2022 through this system, averaging a mere 1.2 seconds of review per claim.

Legal actions have ensued, notably in California and Minnesota, addressing the alleged issues surrounding claims denial practices. In California, two Cigna members filed a class-action complaint, asserting that Cigna bypassed mandatory physician reviews using the PxDx tool, violating state regulations. 

In Minnesota, a member reported being automatically denied coverage for specific services due to the PxDx tool, incurring significant medical bills that were eventually sent to collections.

Moreover, a shareholder in September initiated a lawsuit against Cigna, seeking more insight into the company's claims review process. 

The shareholder expressed concerns about possible mismanagement and wrongdoing within Cigna, anticipating potential regulatory actions and asserting that the automated claims denial approach could adversely impact the company's reputation.

In response to these developments, lawmakers in Pennsylvania have proposed legislation that mandates payers to disclose the application of AI in claims review processes, referencing the concerns raised by the ProPublica report.

Cigna has refuted the allegations made in the ProPublica report, stating that the claims review process adheres to industry standards. They pointed out that the PxDx technology, over a decade old, does not involve algorithms, artificial intelligence, or machine learning.