Cigna Behavioral Health Inc. engaged in “sham” audits and other questionable cost-cutting tactics to reduce payments to medical providers, according to a new lawsuit by a drug and alcohol treatment facility ( Sunrise Detox III, LLC v. Cigna Behavioral Health, Inc. , S.D. Fla., No. 0:17-cv-60170-BB, complaint filed 1/23/17 ).
The lawsuit, filed Jan. 23 by two Sunrise Detox entities, alleges that Cigna launched an improper “cost-savings initiative” against substance abuse treatment centers. Under the initiative, Cigna ramped up unannounced inspections, audits and patient interviews—described in the complaint as “fishing expeditions devoid of due process”—with an eye toward recouping extra money and limiting patient access to medical treatment, the lawsuit claims.
The lawsuit cites both the nationwide opioid and heroin epidemic and the 2008 passage of federal mental health parity laws as drivers for Cigna’s alleged cost-cutting initiative. Cigna adopted these strategies to maintain its financial position in the face of “increased utilization” of substance abuse treatment services, according to the lawsuit.