Cigna PxDx accused of accelerating health insurance claim denials

US healthcare insurance company Cigna came under fire for allegedly using AI and automation to accelerate the processing and denial of claims. A ProPublica investigation accused the company of treating patients unfairly and unethically, and resulted in criticism from patient groups and federal lawmakers. According to ProPublica , Cigna's PxDx system enables doctors to reject patients' claims using a bulk electronic signature without opening or reviewing their files, and to save money by turning down claims it had once paid. In 2022, 80 percent of Medicare Advantage coverage denials were overturned a nd over 300,000 claims over 2 months de nied in this manner. US House Energy and Commerce Committee members wrote to Cigna CEO David Cordan i asking him to offer a detailed explanation of the P x D x review process and usage, an d requesting that he p rovides internal documents about its conception and implementation and business impact . Cigna resp onded by arguing the system had been designed to rapidly approve claims, not reject them, and that it 'involves simple sorting technology that has been used for more than a decade – it matches up codes, and does not involve algorithms, artificial intelligence, or machine learning.' ➕ July 2023. Ayesha Smiley and Suzanne Kisting-Leung sued (pdf) Cigna, arguing its claim reviews were not 'thorough,' 'fair,' or 'objective', as demanded under California law. System 🤖 Cigna PxDx Documents 📃 Cigna (2023). The Facts about Cigna Healthcare's Claims Review Process Cigna (2014). Operating Effectiveness. Portfolio Management Business Impact Assessment Operator: Cigna Developer: Cigna Country: USA Sector: Hea l th Purpose: Review insurance claims Technology: Classification algorithm Issue: Accountability; Business model; Fairness; Transparency Legal, regulatory 👩🏼‍⚖️ Suzanne Kisting-Leung and Ayesha Smiley v Cigna Corporation (pdf) L. R v. Cigna Health & Life Ins. Co US Energy and Commerce Committee (2023). E&C Republicans Press Cigna for Clarification After Investigative Report Accuses Insurance Company of Denying Claims Without Reading Them US Attorney's Office (2022). United States Files Civil Fraud Lawsuit Against Cigna For Artificially Inflating Its Medicare Advantage Payments

Date it happened

2023-03-01

Organisation involved

Cigna

Product, system or model

PXDX

This is a record of what was reported, not a finding that anyone broke the law. If it names your organisation and you believe it is wrong, the corrections process is free and open to everyone.