CIGNA Accused of Stalling RICO Payments
[Posted 08/04/05]

Citing a RICO settlement agreement ordering CIGNA to timely pay damages to physicians, a company that has filed claims on behalf of many CMA members has sued CIGNA for failing to adhere to the terms of the court-ordered agreement.

Managed Care Advisory Group (MCAG) is providing claims-filing services for many CMA members. Its suit accuses CIGNA of giving preferential treatment to claims filed by a competing firm, while denying payment on 600,000 MCAG claims valued at $94 million.

The 2004 settlement with CIGNA calls for all claims to be paid no later than 14 days after the claim period closed February 18. But according to MCAG, none of its Category Two claims had been paid as of June 17, four months after the claims were filed. During same period, Redstone Financial Services—a company that, like MCAG, provided claim-filing assistance to class members—reached a preferential agreement with CIGNA to be paid all of its Category One claims and perhaps as many as 88 percent of its Category Two claims, even though more than 20 percent Redstone’s claims were originally filed with insurers other than CIGNA.

The suit, filed in July, charges CIGNA with inappropriately giving preferential treatment to Redstone clients and asks that all claims be treated the same. In its agreement with Redstone, CIGNA agreed to immediately pay Redstone’s clients $6.3 million and waive all claim documentation requirements for Redstone’s clients.

MCAG’s suit also charges CIGNA with “intentionally obstructing the claims process for all other class members.” MCAG is asking that the court order CIGNA to settle its clients’ claims within 10 days, reopen the claims period to all class members for an additional 90 days, and appoint a third party to assume CIGNA’s settlement payment responsibilities.

If you have submitted claims to CIGNA independently of MCAG and have not received proper payment, contact CMA’s legal information line at 415/882-5144 or legalinfo@cmanet.org. Members who filed through MCAG may contact MCAG at 800/355-0466.

Click here to download a copy of MCAG's lawsuit.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.