Skip to main navigation Skip to main content Skip to footer For Medicare For Providers For Brokers For Employers Español For Individuals & Families: For Individuals & Families Medical Dental Other Supplemental Explore coverage through work How to Buy Health Insurance Types of Dental Insurance Open Enrollment vs. Special Enrollment See all topics Shop for Medicare plans Member Guide Find a Doctor Log in to myCigna
Home Legal MembersHealth Care Fraud

Health Care Fraud

What is health care fraud?

Health care fraud is a crime. It's committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits payable.

Some examples of provider health care fraud are:

  • Billing for services not actually performed;
  • Falsifying a patient's diagnosis to justify tests, surgeries or other procedures that aren't medically necessary;
  • Misrepresenting procedures performed to obtain payment for non-covered services, such as cosmetic surgery;
  • Upcoding – billing for a more costly service than the one actually performed;
  • Unbundling – billing each stage of a procedure as if it were a separate procedure;
  • Accepting kickbacks for patient referrals;
  • Waiving patient co-pays or deductibles and over-billing the insurance carrier or benefit plan;
  • Billing a patient more than the co-pay amount for services that were prepaid or paid in full by the benefit plan under the terms of a managed care contract.

Some examples of consumer health care fraud are:

  • Filing claims for services or medications not received;
  • Forging or altering bills or receipts;
  • Using someone else's coverage or insurance card.

Help avoid and prevent health care fraud

Here are some easy ways you can protect yourself from health care fraud, and keep health care costs down for everyone:

  • Ask questions about the services you receive, such as: Why are they needed? What do they cost?
  • Fill out, sign and date one claim form at a time.
  • Question advertisements or promotions that offer free tests, treatment or services – especially when the provider requests your insurance information or a copy of your Cigna HealthCare ID card.
  • In general, be careful about disclosing your insurance information. Protect your Cigna HealthCare ID card. It represents your benefits.
  • Compare your Cigna HealthCare Explanation of Benefits (EOB) and/or your medical bills with your records. Are the dates of service correct? Were the services actually performed?
  • For those with managed care coverage, question charges exceeding your copayment amount that you're asked to pay by a provider.
  • Let us know if a provider has a practice of waiving copayments or deductibles.
  • Report suspected fraud to Special Investigations.

Cigna is working to minimize health care fraud

Our Corporate Audit Department's Special Investigations (SI) team is responsible for minimizing Cigna's risk to health care fraud. The SI team partners with Cigna's Customer Service Claim Centers and others to help identify suspicious claims, stop payments to fraudulent providers and punish wrongdoers.

The SI team also works with state and federal law enforcement and regulatory agencies and other insurance companies to detect, prevent and prosecute health care fraud. The SI team includes trained professionals with expertise in investigations, health care, nursing, law enforcement and accounting.

How to Report Health Care Fraud

Call the Special Investigations hotline at 

Email us: specialinvestigations@cigna.com

Write to us:
Cigna Special Investigations
900 Cottage Grove Road W3SIU
Hartford, CT 06152

Related Links

Accessibility Statement

HIPAA

Member Rights and Responsibilities

Non-discrimination Notices

Transparency in Coverage

Page Footer

I want to...

Get an ID card File a claim View my claims and EOBs Check coverage under my plan See prescription drug list Find an in-network doctor, dentist, or facility Find a form Find 1095-B tax form information View the Cigna Glossary Contact Cigna

Audiences

Individuals and Families Medicare Employers Brokers Providers

Secure Member Sites

myCigna member portal Health Care Provider portal Cigna for Employers Client Resource Portal Cigna for Brokers

Cigna Company Information

About Cigna Company Profile Careers Newsroom Investors Suppliers Third Party Administrators International Evernorth

 Cigna. All rights reserved.

Privacy Legal Product Disclosures Cigna Company Names Customer Rights Accessibility Non-Discrimination Notice Language Assistance [PDF] Report Fraud Sitemap

Disclaimer

Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.

Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Cigna may not control the content or links of non-Cigna websites. Details