Cigna to Pay Vermont Nearly $400K in Fines

December 3, 2014

The Vermont Department of Financial Regulation (DFR) said Cigna Behavioral Health Inc. has agreed to pay nearly $400,000 to Vermont as the result of an investigation by DFR.

DFR Commissioner Susan L. Donegan said today that the company will pay $342,000 in penalties to the general fund and $50,000 to reimburse the department for the cost of the investigation.

Cigna Behavioral Health is a managed care organization that provides insurance coverage and benefits to Vermonters relating to substance abuse and mental health conditions.

DFR said it has determined that Cigna Behavioral Health used unlicensed mental health review agents to evaluate and allocate patient care. Additionally, the company permitted these agents to make decisions about which services should be covered, provided or reimbursed, DFR said in the announcement. Vermont law states that only agents who have met established standards and are licensed by DFR may conduct these reviews.

Donegan said she appreciated the cooperation received from Cigna Behavioral Health during the investigation and is pleased with the corrective actions it has put in place including additional training for personnel.

“Cigna Behavioral Health has acknowledged the erroneous practices and has made efforts to address the issues,” Donegan said, “I applaud the company’s determination to prevent it from happening in the future. Good compliance is an essential consumer protection.”

Source: Vermont Department of Financial Regulation

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