The United States government has initiated legal proceedings against major health insurance companies—Aetna Inc., Elevance Health Inc. (formerly Anthem), and Humana Inc.—alongside three prominent insurance broker organizations: eHealth Inc., GoHealth Inc., and SelectQuote Inc. The complaint accuses these entities of engaging in unlawful activities, including paying and receiving kickbacks, from 2016 through 2021, to boost enrollment in Medicare Advantage plans.
According to the allegations, these practices involved illegal financial incentives where insurance brokers directed beneficiaries towards certain Medicare Advantage plans based on the amount of kickback they would receive, rather than the actual needs of the Medicare beneficiaries. Consequently, insurance agents were tasked to exclusively sell plans that promised the highest financial returns, sometimes even refusing to offer alternatives from insurers with lower kickback amounts.
The complaint further claims that Aetna and Humana were involved in discriminatory practices against disabled Medicare beneficiaries by conspiring with brokers to reduce enrollment among individuals perceived to be less profitable. Allegedly, this pressure led brokers to divert disabled beneficiaries away from plans offered by Aetna and Humana.
Commenting on these serious allegations, United States Attorney Leah B. Foley remarked, “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. The alleged efforts to drive beneficiaries away specifically because their disabilities might make them less profitable to health insurance companies are even more unconscionable. Profit and greed over beneficiary interest is something we will continue to investigate and prosecute aggressively. This office will continue to take decisive action to protect the rights of Medicare beneficiaries and vulnerable Americans.”
Emphasizing accountability measures, Deputy Assistant Attorney General Michael Granston stated, “Health care companies that attempt to profit from kickbacks will be held accountable. 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 lawsuit has been filed under the whistleblower provisions of the False Claims Act, allowing private parties to bring suits on behalf of the government and potentially share in recoveries. In these cases, the government can intervene, as it has chosen to do here, and may recover thrice its losses plus penalties if liability is established.
This announcement of legal action was made by U.S. Attorney Foley and AAG Granston, acknowledging the support from the Department of Health and Human Services’ Office of the Inspector General and the Federal Bureau of Investigation. The case is being handled by Assistant U.S. Attorneys Charles B. Weinograd and Julien M. Mundele and Trial Attorneys David G. Miller, Anna H. Jugo, Diana E. Curtis, and Sara B. Hanson of the Justice Department’s Civil Division.
The allegations in the complaint remain unproven at this stage, with no judgment on liability made as yet.
