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The Cigna Group

The Cigna Group is an American multinational health services organization headquartered in , that provides , pharmacy benefits management, and related medical services to individuals, employers, and government programs primarily in the United States and internationally. Formed in 1982 via the merger of the , established in 1792 as the first marine insurer in the U.S., and , the company has evolved through acquisitions and divestitures to focus on integrated health solutions, including its Evernorth Health Services division for pharmacy and care delivery. In 2024, The Cigna Group generated total revenues of $247.1 billion, reflecting a 27% increase from the prior year, driven by growth in its , employer health plans, and pharmacy benefits segments, while employing about 73,500 people worldwide. The firm operates in over 30 countries, managing relationships with more than 2 million providers and serving around 178 million customer claims annually, positioning it as one of the largest players in the U.S. market. Notable achievements include expanding offerings and integrating pharmacy services post the 2018 acquisition of , which enhanced its capabilities in specialty drug management and cost containment. The company has encountered substantial controversies, particularly regarding billing practices and claim denials, including a 2023 settlement of $172 million with the U.S. Department of Justice to resolve allegations of submitting invalid diagnosis codes to artificially elevate Medicare Advantage risk adjustment payments, violating the False Claims Act. Additional scrutiny involves claims of systematic use of algorithms to deny patient coverage and recent lawsuits over mismanagement of 401(k) plan forfeitures, highlighting tensions between cost-control measures and obligations to policyholders and regulators.

Company Profile

Overview and Mission

The Cigna Group is an American multinational managed health care and insurance company headquartered in . Formed in 1982 through the merger of the (INA), established in 1792, and the Connecticut General Life Insurance Company, founded in 1865, the company has evolved into a major provider of health services. In February 2023, it rebranded from Cigna Corporation to The Cigna Group to emphasize its structure as a overseeing two primary divisions: Cigna Healthcare, which offers , dental, behavioral, and vision benefits primarily to employers, individuals, and programs in the U.S., and Evernorth Health Services, which provides benefits , specialty , and care delivery solutions. The company operates globally, with a network exceeding 2 million relationships with providers, clinics, and facilities, serving more than 178 million customer relationships worldwide. For the fiscal year ending December 31, 2024, The Cigna Group reported total revenues of $247.1 billion, reflecting significant growth driven by acquisitions such as in 2018 and ongoing expansion in health services. It ranks among the largest U.S. corporations, placing 15th on the 2023 list by revenue. The firm's operations emphasize integrated health solutions, including and behavioral health support, amid broader industry trends toward value-based care and cost containment in response to rising medical expenses. The Cigna Group's stated mission is "to improve the health and vitality of those we serve," guided by core values that prioritize integrity, innovation, customer focus, and teamwork. This mission informs its strategic focus on leveraging data analytics, digital tools, and partnerships to address complex health challenges, such as chronic disease management and access to affordable care, while navigating regulatory pressures and competitive dynamics in the U.S. market. The company's approach underscores a commitment to measurable outcomes over expansive coverage mandates, aligning with that targeted interventions yield better long-term health results than undifferentiated insurance expansion.

Leadership and Governance

David M. Cordani has served as Chairman and of The Cigna Group since September 2009, with his appointment as Chairman effective January 2022. Prior to these roles, Cordani held executive positions at Cigna, including President and CEO of , contributing to the company's strategic expansion in health services. At age 59, he also serves as a since 2009. In March 2025, The Cigna Group announced leadership restructuring to support growth, appointing Brian Evanko as and effective March 31, 2025, overseeing all business lines. Evanko previously led Evernorth Health Services as and CEO. Ann Dennison serves as Executive and , managing financial operations amid the company's focus on cost control and revenue growth. Other key executives include Nicole S. Jones as Executive and General Counsel, and specialized leaders such as David J. Brailer, MD, PhD, in roles. The Board of Directors, which provides strategic oversight, includes Cordani as Chairman and independent members like Eric J. Foss, former CEO of . On June 2, 2025, Michael J. Hennigan was appointed to the board, bringing expertise from his prior roles in . The board maintains an independent majority, with directors representing shareholder interests through periodic evaluations of size and composition. Governance practices emphasize accountability via specialized committees, including the chaired by Kimberly A. Ross, responsible for financial reporting integrity, and the Committee led by Donna F. Zarcone, which handles director nominations and board policies. The board adheres to guidelines promoting ethical conduct, risk oversight, and shareholder engagement, with annual proxy disclosures affirming commitment to transparent practices. These structures support enterprise-wide decision-making, including oversight and compliance with regulatory standards in and services.

Historical Development

Pre-Merger Foundations

The (INA), one of the foundational entities of The Cigna Group, was established in 1792 at Philadelphia's as the first company in the . It issued its inaugural policies that year for the ship America, covering hull and cargo bound for Londonderry, . Incorporated in 1794, INA received authorization to underwrite marine, fire, and risks. The company expanded westward early on, opening its first agency in , in 1807, and by 1876 operated through 1,300 agents nationwide. INA contributed significantly to post-disaster reconstruction in major U.S. cities from 1871 to 1945 and advanced innovations amid growing public interest in the 1910s, with further momentum after . In 1967, it reorganized under INA Corporation as a , and by 1978, ventured into via hospital management and health maintenance organizations (HMOs). The Connecticut General Life Insurance Company (CG), the other key predecessor, was founded in 1865 through a special legislative act signed by the Governor of Connecticut, led by Guy R. Phelps. Initially focused on life insurance, CG pioneered group coverage by introducing the first group life insurance policy in 1913 to 100 employees of the Hartford Courant. It formalized its group operations in 1918, securing a major contract with 5,400 Gulf Oil employees that year. Expanding beyond New England to more than 25 states by the late 19th century, CG diversified in 1962 by acquiring Aetna Insurance Company to bolster property and casualty lines. By 1981, group life and health products accounted for 33% of its income, reflecting a strategic shift toward employee benefits. In 1967, CG established Connecticut General Insurance Corporation as its holding company structure. Both INA and CG built complementary strengths in property/casualty and group health/life insurance, setting the stage for their combination.

Formation and Early Expansion

The CIGNA Corporation was formed on March 31, 1982, through the merger of INA Corporation and , two established entities seeking to consolidate their strengths in , life, and related operations. , tracing its roots to the founded in 1792 as the first marine insurer , brought expertise in property-casualty and international coverage, while , established in 1865 by special act of the Governor, specialized in life and group . The merger created a diversified firm with combined assets exceeding $20 billion and positioned it as a leader in and coverage, amid a consolidating landscape. Following the merger, CIGNA established its headquarters in in 1983, integrating operations from both predecessors to streamline administration and leverage complementary portfolios. Early expansion efforts focused on bolstering international presence and health services; in December 1983, the company agreed in principle to acquire the American Foreign Insurance Association (AFIA), an international underwriting group, which was completed in 1984 and merged into CIGNA International to enhance global property and specialty risk coverage. Additionally, INA's pre-merger 1980 purchase of Ross-Loos Medical Group—the nation's oldest (HMO), founded in 1929—was integrated into CIGNA's health operations, supporting expansion into models amid rising demand for cost-controlled health plans. By 1987, CIGNA reorganized its property-casualty lines by renaming the acquired Insurance subsidiary as CIGNA Property and Casualty Insurance Company, reflecting efforts to unify branding and operations while navigating challenges like underwriting losses in non-health segments that totaled $423 million in the first three quarters of 1982 alone. These steps laid the groundwork for a shift toward health-focused growth, with the company prioritizing group health and benefits to capitalize on demographic trends and regulatory changes favoring employer-sponsored coverage.

Modern Growth and Rebranding

The merger with Express Scripts, completed on December 20, 2018, for approximately $67 billion, represented a cornerstone of Cigna's modern expansion strategy, integrating its medical, dental, and vision insurance operations with one of the largest pharmacy benefit managers (PBMs) in the United States. This combination expanded Cigna's addressable market by adding Express Scripts' network of over 1.4 million pharmacies and its management of pharmaceutical benefits for more than 100 million members, enabling synergies in cost containment, data analytics, and service integration that the company projected would drive annual cost savings exceeding $1 billion. Post-merger, Cigna's first-quarter 2019 revenue tripled to $30.4 billion compared to the prior year, reflecting the immediate scale from incorporating Express Scripts' $25 billion quarterly revenue stream, while its integrated medical benefits segment grew 12.8% to $9.2 billion. Subsequent years saw sustained revenue expansion, fueled by organic growth in employer-sponsored plans, Medicare Advantage enrollment, and PBM services amid rising healthcare utilization. Cigna's annual revenue climbed from $153.6 billion in 2019 to over $247 billion in 2024, with trailing twelve-month revenue reaching $262 billion as of June 30, 2025, marking a 20.23% year-over-year increase driven by Evernorth's pharmacy services, which accounted for a growing share of total revenues. In the second quarter of 2025 alone, total revenues rose 11% to $67.2 billion, supported by 7% growth in Evernorth adjusted revenues to $47.5 billion, though offset somewhat by medical cost pressures in the Cigna Healthcare segment. Strategic investments, such as Evernorth's $3.5 billion infusion into a former specialty pharmacy network in September 2025, further bolstered capabilities in high-cost drug management, enhancing competitive positioning in a market where PBMs handle over 80% of U.S. prescriptions. Rebranding efforts aligned with this diversification, beginning with the September 2020 launch of Evernorth as the umbrella for Cigna's health services portfolio, encompassing Express Scripts, Accredo specialty pharmacy, and eviCore utilization management to unify non-insurance operations under a distinct identity. This was followed by a comprehensive corporate rebrand in February 2023 to The Cigna Group, establishing Cigna Healthcare for insurance products and Evernorth Health Services for pharmacy, behavioral health, and care delivery, better reflecting the company's evolution from a traditional insurer to a diversified health services provider serving 178 million customer relationships globally. The rebranding, which employed 70,000 people across 30 countries, aimed to clarify brand architecture amid portfolio expansion while maintaining consumer trust in core offerings, as articulated by leadership emphasizing continuity in mission despite structural changes. These initiatives coincided with a focus on operational efficiencies, though empirical analyses of similar consolidations have noted potential premium elevations in segments like Medicare Part D due to reduced competition, underscoring trade-offs in scale-driven growth.

Business Operations

Cigna Healthcare Division

Cigna Healthcare operates as the health benefits division of The Cigna Group, encompassing U.S. commercial employer plans, U.S. government programs, and coverage. Established through a rebranding to delineate it from the Evernorth Health Services division, it focuses on delivering medical, , behavioral health, dental, , supplemental, and solutions to promote across diverse populations. In the U.S. employer segment, Cigna Healthcare provides comprehensive plans including medical coverage, pharmacy benefits, behavioral health and wellness programs, vision and , supplemental health options, and flexible spending arrangements such as health reimbursement accounts (), health savings accounts (HSAs), and flexible spending accounts (FSAs). The U.S. government business includes plans offered through subsidiaries like HealthSpring, alongside individual and family plans with integrated medical, vision, dental, and pharmacy components. Internationally, it supports expatriates, employers, intergovernmental organizations (IGOs), and nongovernmental organizations (NGOs) with tailored health plans available in over 200 countries and jurisdictions. As of 2024, Cigna Healthcare serves approximately 19.1 million medical customers, reflecting its scale in delivery. Dental plans attract over 17 million participants, supported by networks emphasizing lower deductibles and broad provider access. Vision coverage leverages one of the largest specialty networks for routine and medical eye care. These operations prioritize integrated benefits design to address employer, individual, and global client needs, with integration handled in coordination with Evernorth but administered under Healthcare's umbrella for plan members.

Evernorth Health Services Division

Evernorth Health Services constitutes one of The Cigna Group's two primary operating segments, alongside Cigna Healthcare, focusing on pharmacy benefits management, specialty pharmacy, , behavioral health, and integrated care delivery solutions. Rebranded in September 2020 to unify Cigna's existing health services portfolio, it integrates capabilities from acquisitions such as , acquired in 2018 for $67 billion, to provide scalable solutions aimed at reducing costs and improving health outcomes for employers, health plans, and government programs. The division operates through a network of subsidiaries and brands, emphasizing data-driven interventions to address complex healthcare challenges like medication adherence and chronic disease management. Core offerings include , which manages benefits for over 100 million members and handles mail-order and retail prescriptions to optimize drug utilization and pricing. provides specialty services for high-cost, complex therapies, such as those for and rare diseases, delivering home-based infusions and patient support programs. eviCore specializes in evidence-based for medical, behavioral, and services, reviewing prior authorizations to ensure clinical necessity while controlling expenditures. Additional components encompass MDLIVE for virtual care consultations and Evernorth Care Group, a network of clinics rebranded from Cigna Medical Group in 2022, offering integrated services like , , and onsite behavioral health in select markets. The division extends into behavioral health through measurement-based care programs, which track patient progress via standardized assessments to adjust treatments dynamically and enhance provider efficiency. Care enablement tools, such as CareNav+, facilitate personalized benefits navigation for employees, integrating , , and postpartum support to simplify access and lower overall costs. Partnerships with hospitals and health systems further enable efficiencies in fragmented care ecosystems, including EncircleRX for closed-door pharmacies tailored to institutional needs. These services collectively serve diverse clients, from large employers to entities, by leveraging proprietary data analytics for predictive modeling and strategies. Financially, Evernorth has driven significant growth for The Cigna Group, with segment revenues reaching $57.8 billion in the second quarter of 2025, a 17% increase year-over-year, fueled by expanded volumes and specialty services. For the full year 2024, Evernorth contributed to the company's total revenues of $247.1 billion, up 27% from 2023, underscoring its role in diversifying beyond traditional through high-margin services. Adjusted income from operations in the segment reflected robust margins, supported by operational scale and cost containment measures amid rising drug prices.

International Presence

The International Health operating segment of The Cigna Group delivers medical coverage, coordinated behavioral health, dental, vision, and other ancillary services to expatriates, globally mobile individuals, employers, and international governmental organizations (IGOs) and nongovernmental organizations (NGOs). This segment focuses on tailored plans for personal, family, retirement, student, and group needs, supported by a network exceeding 1.5 million hospitals and healthcare professionals across more than 200 markets and territories. Operations emphasize 24/7 multilingual assistance in over 50 languages, enabling access to care without geographic restrictions in many plans. Key operational hubs include offices in , (), [Hong Kong](/page/Hong Kong), , , , , and (), facilitating localized support in , , , and the [Middle East](/page/Middle East). In , the company maintains a dedicated unit with over 60 years of experience serving international organizations, providing 24/7 regional support and tailored group benefits. Expansion into dates back to the late , with Cigna International marking 20 years of operations in and [Hong Kong](/page/Hong Kong) by 2009. The segment serves customers in over 30 countries, prioritizing and multinational employee needs through products like , launched in March 2011 to target individual markets for globally mobile persons.

Financial Performance

The Cigna Group's total revenues grew steadily from $153.6 billion in 2019 to $195.3 billion in 2023, reflecting expansion in its pharmacy benefits management through Evernorth and segments, before surging to $247.1 billion in 2024, a 27% increase attributed to strong performance in both Cigna Healthcare and Evernorth divisions. This 2024 acceleration followed organic growth and operational efficiencies, with adjusted revenues also rising 27% year-over-year. Shareholders' net income exhibited greater volatility over the same period, peaking at $8.5 billion in 2020 amid favorable market conditions and one-time gains, before declining to $3.4 billion in 2024 due to higher medical costs, regulatory pressures, and adjustments in the healthcare segment. The 2023 of $5.2 billion represented a 23% drop from 2022's $6.7 billion, influenced by increased utilization in medical benefits and integration costs from prior expansions.
YearRevenue ($B)Year-over-Year Change (%)Net Income ($B)Year-over-Year Change (%)
2019153.6-5.1-
2020160.4+4.58.5+66.7
2021174.1+8.55.4-36.5
2022180.5+3.76.7+24.1
2023195.3+8.25.2-22.4
2024247.1+26.63.4-34.6
Looking ahead, The Cigna Group reaffirmed its 2025 adjusted outlook of at least $29.60, signaling expectations for earnings recovery amid projected revenue growth in pharmacy services and cost management initiatives.

Market Share and Competitive Standing

The Cigna Group ranks as the fourth-largest health insurer in the United States by in the employer-sponsored insurance segment, holding approximately 11% as of December 2024. This positions it behind at 15%, at 12%, and (including ) at 12%, with the top five insurers collectively controlling over 50% of the market and contributing to heightened concentration concerns. metrics, derived from enrollment and premiums data, underscore Cigna's focus on commercial group plans, where it maintains a strong foothold among large employers, though it ceded ground in by divesting that business to in March 2024 for $3.7 billion to prioritize higher-margin segments.
InsurerApproximate U.S. Employer-Sponsored Market Share (2024)
15%
12%
(Aetna)12%
The Cigna Group11%
Health Care Service Corp.7%
Cigna's competitive standing benefits from its integrated model, combining medical insurance with the Evernorth health services division—particularly via —which generated significant revenue synergies and differentiated it from pure-play insurers like . In , total revenues reached $247.1 billion, a 27% year-over-year increase, supporting adjusted of $26.57 and reinforcing financial resilience amid rising medical costs and regulatory scrutiny on industry consolidation. However, its position faces pressure from by rivals such as UnitedHealth's , which captures more data-driven efficiencies, and from antitrust concerns over market dominance that could limit further acquisitions. Strong insurer financial strength ratings, including A.M. Best's A (excellent) for key subsidiaries as of June 2025, affirm operational stability but highlight vulnerabilities in claims management practices that have drawn litigation.

Technological and Operational Innovations

AI and Algorithmic Tools in Claims Management

The Cigna Group employs the PXDX (procedure-to-diagnosis) as a core tool in claims management, designed to verify medical necessity by matching submitted procedure codes against diagnosis codes in accordance with clinical coverage policies. This rules-based system primarily targets approximately 50 common, low-cost post-service procedures, such as screenings and , enabling rapid review without initial manual file examination. Developed over a decade ago, PXDX flags potential mismatches for medical director oversight, facilitating bulk processing to expedite routine approvals. In operation, PXDX automatically approves 94% of applicable claims, with denials for less than 1% of Cigna's overall claims volume; flagged denials undergo physician , often allowing resubmission with corrected codes or appeals. Cigna reports that this process accelerates payments for straightforward cases, reducing administrative burden while maintaining human oversight for exceptions. Investigative reporting indicates that in early , Cigna directors denied over 300,000 PXDX-flagged claims across two months, averaging 1.2 seconds per , with individual physicians handling up to 80,000 denials monthly through batch sign-offs without accessing patient records in many instances. Beyond PXDX, Cigna integrates and in broader claims processing to enhance accuracy and speed, utilizing patent-pending technology that analyzes claims data for faster turnaround and improved first-call resolutions, while preserving human for complex cases. In June 2025, Cigna Healthcare launched -powered features in its myCigna portal, including a smart claim submission tool that scans uploaded bills, auto-populates details, and delivers plain-language status updates, alongside a for claims inquiries that has shown 80% user satisfaction in early pilots. These tools aim to streamline provider and member interactions, though Cigna emphasizes they complement rather than replace clinical judgment.

Data-Driven Health Solutions

The Cigna Group utilizes and through its Evernorth Health Services division to identify at-risk individuals and facilitate targeted interventions aimed at improving health outcomes and reducing costs. These efforts integrate data from medical claims, pharmaceutical records, digital devices, and third-party sources to address care fragmentation, with applications such as enhancing medication adherence for chronic conditions like by detecting patterns like under-ordering of insulin and recommending cost-effective alternatives. In one reported instance, such enable early to prevent escalation of musculoskeletal (MSK) issues, using models to predict potential needs and coordinate evidence-based programs. Evernorth's Intelligence Plus employs advanced modeling to detect patterns, calculate risks, and provide multi-dimensional insights for plan diagnostics, combining with behavioral science for precise outreach and gap prevention. The Health Connect 360° , part of Evernorth, aggregates disparate channels into a unified view to support care coordination and employer dashboards that track activity and cost drivers, purportedly lowering prescription expenses where one in eight Americans otherwise skips doses due to affordability. The Evernorth further refines these capabilities by developing methodologies for actionable intelligence from large-scale , while the Vitality measures individuals' capacity to inform vitality-focused interventions. Pathwell, launched in September 2022, exemplifies integration of Evernorth analytics with Cigna Healthcare benefits, offering concierge-style programs initially for MSK conditions and specialty pharmacy needs like biologics infusions. It leverages predictive tools to forecast surgeries up to a year in advance, enabling personalized options such as virtual , behavioral health support, and peer networks to avert unnecessary procedures and high-cost care, with expansions planned for and . In June 2025, Cigna Healthcare introduced AI-enhanced digital tools blending analytics with human oversight to guide customers through health journeys, incorporating for proactive support. These initiatives, prototyped via The Lab at Evernorth, emphasize outcomes over volume, though independent studies validating broad-scale efficacy remain limited, with company reports citing internal improvements in adherence and coordination.

Automated Claims Denial Practices

In 2023, investigative reporting revealed that Cigna Healthcare utilizes a proprietary system known as PXDX (procedure-to-diagnosis) for post-service claims processing, which automatically flags mismatches between submitted procedure codes and required diagnosis codes specified in Cigna's clinical coverage policies. This enables Cigna-employed physicians to approve denials for batches of claims—sometimes hundreds or thousands at a time—without accessing individual patient medical records, with an average review time of 1.2 seconds per case. For instance, in two months of 2022, the system facilitated the denial of over 300,000 claims, including one physician approving approximately 60,000 denials in a single month. Critics, including patient advocates, argue this approach prioritizes efficiency and cost savings—estimated in the millions annually for specific procedure categories—over thorough medical necessity assessments, potentially leading to improper denials of covered services. Cigna maintains that PXDX is a straightforward code-matching tool aligned with (CMS) guidelines, not an or algorithmic system designed for arbitrary denials. The company reports that 94% of claims are automatically approved without intervention, with denials affecting less than 1% overall and targeting low-cost procedures such as screenings or , which comprise about 50 specific codes. Denied claims can be resubmitted by providers with corrected codes, often resulting in automatic payment, and in-network patients incur no out-of-pocket costs from initial denials. Cigna emphasizes that the process includes options for physician discussion with medical directors and appeals, asserting no financial incentive exists to deny valid claims since payments follow policy-compliant resubmissions. The practice has sparked multiple class-action lawsuits under the Employee Retirement Income Security Act (ERISA), alleging that bulk denials without individualized review deprive plan participants of a "full and fair" benefits determination. Filed starting in July 2023, these suits cite examples such as denials for medically necessary tests later overturned on appeal after delays of months, potentially exacerbating patient health risks. In March 2025, U.S. District Judge Dale Drozd in the Eastern District of California partially denied Cigna's motion to dismiss, allowing claims to proceed on grounds that the system's speed and lack of file review may violate ERISA requirements, though dismissing certain state-law allegations. As of October 2025, the litigation remains ongoing, with no final resolutions reported, highlighting broader scrutiny of automated tools in claims amid concerns over access to care.

Nataline Sarkisyan Case

Nataline Sarkisyan, a 17-year-old resident diagnosed with , underwent aggressive that induced fulminant as a side effect. Her physicians at UCLA Medical Center, including the head of the transplant unit, recommended an emergency liver transplant to address the irreversible liver damage, asserting it was medically necessary for survival. On December 11, 2007, Cigna HealthPlan, her insurer, denied coverage for the procedure, classifying it as experimental, investigational, and unproven under the policy terms, despite the lack of alternative treatments. The Sarkisyan family pursued multiple appeals, supported by UCLA doctors who provided evidence of the transplant's potential efficacy in similar pediatric cases of drug-induced secondary to treatment. Cigna upheld the twice, citing the procedure's unestablished safety and effectiveness for this specific condition, which delayed scheduling amid her deteriorating condition. Public protests erupted, led by the California Nurses Association, accusing Cigna of prioritizing cost containment over patient care, drawing national media scrutiny to insurer practices. Cigna maintained that the pertained solely to payment, not the medical recommendation, and noted internal reviews aligned with evidence-based guidelines at the time. On December 20, 2007, hours after Sarkisyan's condition became terminal, Cigna reversed its decision and authorized coverage, but she died that evening from before the transplant could occur. The family blamed the insurer's delays for the fatal outcome, filing a wrongful against Cigna in December 2008, alleging bad-faith denial and rejection of valid claims that hastened her . The case highlighted tensions between insurer cost-control mechanisms and judgments, though federal ERISA protections limited the family's ability to pursue full damages, leading to an out-of-court settlement whose terms were not publicly disclosed. The incident spurred advocacy for reforms in transplant coverage policies, though no immediate California-specific mandate emerged directly from it. In July 2023, a class-action lawsuit, Kisting-Leung et al. v. Cigna Corporation et al., was filed in the U.S. District Court for the Eastern District of California, alleging that Cigna employed its proprietary PxDx algorithm—an AI-driven tool that cross-references procedure codes against diagnosis codes—to automatically deny hundreds of thousands of pre- and post-service claims without meaningful medical review by physicians, in violation of ERISA fiduciary duties and the terms of participants' health plans requiring individualized assessments. The suit claimed the algorithm flagged discrepancies to prioritize cost savings over patient care, resulting in wrongful denials that delayed or prevented access to necessary treatments. Subsequent filings and investigations revealed the PxDx system's scale: in a two-month period in 2019, it processed over 300,000 claims, denying a significant portion automatically before any human intervention, prompting additional class actions in 2023 and 2024 asserting similar breaches. In March 2025, a Texas-based law firm expanded scrutiny by filing suits against Cigna alongside Humana and UnitedHealth Group, accusing them of systemic AI misuse to reject claims en masse, exacerbating financial burdens on patients and providers. Court developments in 2025 advanced these cases: on April 8, U.S. District Judge Dale A. granted Cigna partial in the Kisting-Leung matter, dismissing certain -plaintiff claims but permitting patient claims to proceed on grounds that the algorithm's automated denials contradicted plan language mandating doctor oversight. Later that month, on April 22, the Eastern District of ruled the lawsuit could advance, citing violations of insurance code and ERISA due to the lack of review in AI-driven decisions. These rulings underscore ongoing debates over AI's role in claims processing, with critics arguing it incentivizes denials to reduce payouts while defendants maintain the tool enhances efficiency without overriding clinical judgment. As of September 2025, the litigation remains active, with potential implications for broader regulatory oversight of algorithmic tools in , including risks of breaches if supplants required human evaluation. No settlements have been reported in these AI-specific cases, distinguishing them from Cigna's resolved disputes over unrelated practices like network adequacy.

Public Policy Engagement

Lobbying and Advocacy Efforts

The Cigna Group conducts extensive federal on healthcare-related , with expenditures totaling $8.25 million in 2024 and $5.35 million in 2025 through available reporting periods. These efforts, disclosed quarterly to the U.S. and , target policies influencing operations, cost structures, and . Key advocacy focuses encompass enhancing healthcare affordability, expanding access, and promoting operational flexibility for insurers, employers, and providers, as articulated in the company's framework. In areas like (PBM) and drug pricing, Cigna has lobbied intensively amid rising regulatory scrutiny, including support for measures such as S. 1040, the Drug Competition and Enhancement Act, aimed at fostering and . Such positions align with industry-wide pushes to counter proposals for stricter PBM transparency or pricing controls that could elevate costs for large insurers. The company's (), funded by employee contributions, raised approximately $2.5 million in the 2023-2024 election cycle and directed funds to bipartisan candidates and committees, including $50,000 each to its and National entities. Historically, Cigna has backed 527 organizations challenging provisions, particularly those impacting prescription drug costs, reflecting a preference for market-oriented reforms over expansive mandates. More recently, lobbying has addressed extensions of ACA subsidies set to expire, alongside broader industry efforts to shape and commercial insurance rules following Cigna's 2024 divestiture of its business for $3.7 billion. These activities underscore Cigna's strategic engagement to mitigate regulatory risks and preserve profit margins in a sector where lobbying by major health plans hit record levels in 2023.

Interactions with Healthcare Regulations

The Cigna Group maintains compliance programs aligned with key federal healthcare regulations, including the Health Insurance Portability and Accountability Act (HIPAA), which mandates standardized electronic transactions and safeguards for ; Cigna adheres to these by requiring providers to use compliant formats and codes for claims processing. Under the (ACA), Cigna has adapted operations to provisions such as guaranteed availability and renewability of coverage, single risk pools, and rating restrictions, while also implementing employer mandate requirements for plans offering minimum value coverage since 2016. These adaptations include providing standardized Summary of Benefits and Coverage documents to facilitate plan comparisons, as required by ACA regulations. In Medicare Advantage programs, Cigna interacts with (CMS) regulations on risk adjustment, submitting diagnosis codes for payment calculations; a 2023 Office of Inspector General examined specific codes under Cigna's contract H4513 and identified instances of unsupported submissions, prompting enhanced internal validation processes. The company resolved related allegations in September 2023 by paying $172 million without admitting liability, affirming its commitment to regulatory-compliant risk adjustment practices amid industry-wide scrutiny. Separately, in October 2023, Cigna settled claims of submitting invalid diagnosis codes to inflate payments for $37 million, again resolving without conceding fault. State-level regulatory interactions include enforcement for mental health parity compliance; in 2025, Virginia imposed $503,000 in fines across three actions against Cigna for violations of parity laws requiring equitable coverage for services. Cigna also engages with coverage policy development, establishing criteria for plans where federal rules like National Coverage Determinations are absent, allowing plan-specific decisions subject to oversight. These interactions reflect ongoing navigation of evolving rules, including supplemental benefits compliance amid regulatory changes affecting plan options.

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