CARMEL, INDIANA, October 17, 2014. Health insurance giant CIGNA and medical billing giant Zotec Partners have been accused of colluding to raise premiums in a lawsuit filed by a whistleblower who worked for both companies. Former employee Peter Bonewitz reveals that CIGNA has been able to artificially steer premiums through incentives, strategic claims acceptance and by leveraging weaknesses in the ICD-9 coding system. He also alleges that Zotec Partners has been coding false claims to meet CIGNA’s needs while passing expensive procedures onto the consumer—a win-win process that allows both to be more profitable.
In the suit filed in the Circuit Court for Davidson County, Tennessee at Nashville Bonewitz, of Carmel, Ind., says that he raised his concern about fraud with both CIGNA and Zotec Partners’ representation, but they failed to address the issues, except for Zotec’s response that the company’s behavior was no different to that of other medical billing companies. The suit states: “This manipulative process has resulted in artificially increasing the risk of CIGNA members and has been highly influential in inflating premium prices for ALL CIGNA members.”
As a result of Zotec Partners’ practices, Bonewitz says that when he was a CIGNA employee he personally paid a higher premium than he would have paid had they coded following ‘best practices’ with physician supervision and not specifically to have certain claims accepted. He holds CIGNA and Zotec Partners equally responsible. Bonewitz, who worked as a business intelligence analyst, and is seeking a trial by jury, alleges that CIGNA committed consumer fraud and fraudulently induced him to purchase its health insurance services. He claims breach of fiduciary duty in their not investigating false claims and actively suppressing negative information including numerous lawsuits, fines and charges filed against the company. Bonewitz also alleges that CIGNA committed wire fraud, negligence, breach of contract and breach of promises.
The suit maintains: “Together, CIGNA’s and Zotec Partners’ unscrupulous methods have made disputing medical bills enormously complex and convoluted with the intent of placing an undue burden on CIGNA members, resulting in tremendous unfair damages. Bonewitz further maintains that he suffered damages as a result of making co-payments for testosterone treatments he otherwise would not have been responsible for, breach of fiduciary duty, breach of contract and breach of promises.
He is seeking compensation of an estimated one hundred million dollars for appropriate back pay and loss of future earnings; emotional pain and suffering, mental anguish and loss of enjoyment of life; punitive damages; attorneys fees; and costs.
Bonewitz has developed a personal blog that shares his concerns of fraud and the challenges he has faced. www.healthfraudalert.com
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