The U.S. Department of Justice (DOJ) filed a complaint on Thursday against three Medicare Advantage insurers and three insurance broker organizations, alleging that the insurers paid illegal kickbacks to the brokers to increase enrollment into their plans.
The insurers named in the complaint are Aetna, Elevance Health and Humana, while the brokers are eHealth, GoHealth and SelectQuote. The DOJ alleged that from 2016 through at least 2021, the insurers paid hundreds of millions of dollars in kickbacks to the brokers. Kickbacks are illegal payments in exchange for favorable treatment. The complaint was filed in the U.S. District Court for the District of Massachusetts under the False Claims Act.
To choose a Medicare Advantage plan, many seniors rely on brokers to help find the option that best meets their needs. However, the DOJ contends that some brokers may steer seniors toward plans from insurers offering the largest kickbacks, rather than those that are the most suitable for the individual.
The complaint stated that the defendant brokers incentivized employees and agents to sell plans from insurers with the most kickbacks, and that they would sometimes refuse to sell MA plans from insurers that did not pay enough in kickbacks.
“Health care companies that attempt to profit from kickbacks will be held accountable,” said Deputy Assistant Attorney General Michael Granston of the Justice Department’s Civil Division in a statement. “We are committed to rooting out illegal practices by Medicare Advantage insurers and insurance brokers that undermine the interests of federal health care programs and the patients they serve.”
The DOJ also alleged that Aetna and Humana worked with the defendant brokers to discriminate against Medicare beneficiaries with disabilities who they considered to be less profitable. They did this by threatening to withhold kickbacks so that brokers would enroll fewer beneficiaries with disabilities in those plans and direct them to other plans, according to the complaint.
“It is concerning, to say the least, that Medicare beneficiaries were allegedly steered towards plans that were not necessarily in their best interest – but rather in the best interest of the health insurance companies,” said U.S. Attorney Leah B. Foley for the District of Massachusetts, in a statement. “The alleged efforts to drive beneficiaries away specifically because their disabilities might make them less profitable to health insurance companies are even more unconscionable.”
Several of the defendants pushed back on the complaint. A spokesperson for Elevance Health said that the company is confident its health plans have “complied with and continue to comply” with the rules and guidelines outlined by the Centers for Medicare and Medicaid Services (CMS) and will fight the allegations.
Similarly, a spokesperson for Aetna said the insurer designed and executed its marketing programs and compensation to brokers to comply with CMS.
“We remain committed to providing high quality insurance products for diverse individual needs and strive to ensure that each individual is in the best plan for their needs. We dispute the allegations and intend to defend ourselves vigorously,” said Phillip Blando, the Aetna spokesperson.
A spokesperson for Humana also said the insurer disagrees with the allegations and will defend itself in legal proceedings. The spokesperson added that Humana’s “highest priority remains ensuring our members are provided with outstanding healthcare coverage and access to care.”
The brokers also disputed the allegations, with a SelectQuote spokesperson saying that the company has “always been a high-integrity organization that has abided by all applicable rules and regulations. We put the best interests of the customers at the forefront of what we do and believe these claims are baseless.”
In a statement, eHealth noted that the company has fully cooperated with the DOJ since being notified of its investigation in 2022.
“eHealth strongly believes the claims are meritless and remains committed to vigorously defending itself,” the company said.
GoHealth did not immediately return a request to comment.
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