Whistleblower Alleges CIGNA and Medical Billing Giant Zotec Partners are Colluding to Hike Premiums

CARMEL, Ind., Oct. 29, 2014 /PRNewswire/ -- A former insider at CIGNA and medical billing company Zotec Partners made bombshell allegations of fraud and collusion in a series of lawsuits filed in federal and state courts which he has published in his newly released health care blog www.HealthFraudAlert.com.

The Fraud revelations could impact thousands of Affordable Care Act, Medicare Advantage and private CIGNA members.

Whistleblower Pete Bonewitz, Senior Business Intelligence Analyst for both companies, claims that CIGNA Corporation and Zotec Partners have been colluding to increase health insurance premiums in order to defraud Medicare and private insurance members.

Bonewitz reveals that CIGNA artificially increases premiums through incentives, strategic claims acceptance and by leveraging weaknesses in the ICD-9 coding system.

And he alleges that Zotec Partners has been coding false claims to meet CIGNA's needs while unscrupulously passing expensive procedures onto the consumer—a win-win process that allows both companies to be more profitable.

In a 58-page civil law suit filed in the Circuit Court for Davidson County, Tennessee at Nashville, Bonewitz, of Carmel, Ind says that he raised his concerns about fraud with both CIGNA and Zotec Partners' representation and, despite the evidence he presented, they responded with a series of stonewalling and retaliation. He's published more extensive details in his blog.

Bonewitz says, "Together, CIGNA and Zotec Partners' unscrupulous methods have made disputing medical bills enormously convoluted with the intent of placing an unnecessary burden on members."

The suit states, "This manipulative process has resulted in artificially increasing the risk of ALL CIGNA members."

Further, Bonewitz reveals CIGNA's unconscionable inside practices; corrupt internal investigation, containing the employee who reports fraud, and isolating Compliance; in order to conceal wrongdoing.

Bonewitz also alleges that CIGNA members paid higher premiums than they would have paid had Zotec coded following 'best practices' with physician supervision and not specifically to have certain claims accepted to meet CIGNA's needs.  He holds CIGNA and Zotec Partners equally responsible.

Bonewitz maintains that CIGNA committed consumer fraud and fraudulently induced him to purchase its health insurance services; indicating that CIGNA's gross violations of trust have immensely devalued the premium and have compromised the value of care. He claims negligence in their not investigating false claims and actively suppressing negative information including numerous lawsuits, fines and charges filed against the company. In addition he alleges that CIGNA committed wire fraud, breach of contract and breach of fiduciary duty.

Bonewitz also has wrongful termination lawsuits filed against CIGNA/HealthSpring and Zotec Partners for Violations of the False Claims Retaliation Provision (31 U.S.C. § 3730 (h)).  He claims that both companies wrongfully terminated him after he brought concerns that they were also defrauding Medicare/CMS.

In October 2011, just after reporting his concerns to CIGNA a nationwide FBI fraud bust occurred that involved several major HealthSpring providers. Bonewitz indicated to attorneys that this was proof that CIGNA/HealthSpring was not looking for specific false claims that artificially raise risk and wanted them to occur. Days later Bonewitz's data access was removed per instruction of 'the owners' and then he was suspended.  

Bonewitz further maintains that he suffered damages as a result of controversial testosterone treatments that he believes were wholly unnecessary and are being wrongfully accepted by CIGNA in order to artificially increase male risk.

Since Bonewitz's wrongful termination he has been tracking CIGNA's actions and has reported concerns that CIGNA may be deliberately funneling revenue through third-party companies in order to conceal data and dilute profits.

Revelations from these lawsuits could have serious implications on CIGNA's global business partnerships in Europe and Asia.

Bonewitz seeks to depose key witnesses and reveal critical evidence related to the wrongdoings. He is seeking compensation of an estimated $100 million for appropriate back pay and loss of future earnings; emotional pain and suffering, mental anguish and loss of enjoyment of life; punitive damages; attorney's fees; and costs.

To learn more about the fraud concerns and to find out if they may be relevant to you go to www.HealthFraudAlert.com.  You may find the Civil Complaints 14c-4350, 3:14cv0096 and 1:2014cv01464 listed at: https://www.scribd.com/doc/244811478/CIGNA-ZotecPartners-Fraud-Complaint

Contact: Peter Bonewitz      
Phone: 317.797.7889
Email

SOURCE Peter Bonewitz