Cigna sued by shareholder following ProPublica report on mass claim denials

 By: Jacob Emerson    September 14, 2023


A shareholder is suing the Cigna Group in Delaware's Court of Chancery to obtain more information about the company's claims review process following a ProPublica report that alleges the company denies large batches of members' claims without individual review, Law360 reported Sept. 13.

The shareholder, Charles Blackburn, said he attempted to seek more information from Cigna directly following the March report from ProPublica, which claims the insurer uses an algorithm called "PXDX" to complete the review and allow physicians to sign off on groups of denied claims, a process that may save the company millions of dollars every year when members don't appeal. 

According to Law360, Mr. Blackburn did not receive the requested information, which includes reports about the "legality or financial impact" of the PXDX tool.  He is looking to "investigate possible mismanagement and/or breaches of fiduciary duty and other wrongdoing" by Cigna, and additional lawsuits could occur.

"There is reason to believe that the company's use of automated systems to deny insurance claims will result in regulatory action and has already caused reputational harm," the complaint said, per Law360.

Read the full article here.