Cigna / David Cordani

◼ Origin

Cigna Group is the third-largest US health insurer by revenue, serving 18 million insurance customers while processing claims for 100+ million Americans through its Evernorth pharmacy benefit arm. The company built the PXDX system — an automated tool that allowed its employed doctors to batch-deny insurance claims in seconds without reviewing patient records. In 2022, Cigna doctors denied 300,000 claims at an average of 1.2 seconds each. When patients appealed, 80% of those denials were reversed. The company knew this. It built the system anyway, counting on the fact that only 5% of patients would fight back. When 17-year-old Nataline Sarkisyan needed a liver transplant, Cigna classified it as experimental and said no. She died hours after the company reversed course under public pressure. The wrongful-death suit was dismissed under ERISA — the federal law, shaped by decades of industry lobbying, that shields employer-paid health plans from damages over coverage denials. Cigna CEO David Cordani earned $23.25 million in 2024 while presiding over this system. In 2024, Cigna paid $172 million to settle a federal lawsuit alleging it had falsely inflated Medicare Advantage payments by attaching phantom diagnoses to patient records for five years. No executive was charged.

◼ Self-Made Verdict — YES

Cigna built a system designed to deny claims without reading them, projected that most patients would not appeal, and deployed it at scale. Nataline Sarkisyan died within hours of a reversal that came too late. The DOJ settled $1.4B in Medicare fraud for $172M. The ERISA shield blocked wrongful-death damages. Every element of the public record supports a verdict of yes.

◼ Documented marks