The U.S. Department of Justice has accused several major health insurers of spending hundreds of millions in kickbacks to influence large broker firms to enroll individuals in their Medicare Advantage plans.
Aetna and its affiliates, Elevance Health, and Humana are at the center of the lawsuit, which was filed in federal court in Massachusetts. The alleged scheme operated from 2016 through at least 2021.
The lawsuit also includes accusations that Aetna and Humana attempted to pressure brokers by threatening to withhold kickback payments unless the brokers reduced the number of disabled Medicare beneficiaries they enrolled.
According to the Justice Department, this led brokers to reject referrals for disabled individuals and divert them from plans offered by Aetna and Humana.
Major brokerage firms named in the suit include Health, GoHealth, and SelectQuote. The Justice Department claims these companies rewarded employees for selling plans linked to kickbacks, formed teams to sell only those plans, and in some cases refused to sell Medicare Advantage products from insurers that did not provide comparable financial incentives.
U.S. Attorney Leah B. Foley of Massachusetts stated that the redirection of Medicare beneficiaries to plans based on insurer profit rather than patient interest is highly troubling. She said the reported targeting of disabled individuals due to potential cost concerns is especially serious.
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
U.S. Attorney Leah B. Foley for the District of Massachusetts
“The alleged efforts to drive beneficiaries away specifically because their disabilities might make them less profitable to health insurance companies are even more unconscionable,” Leah B. Foley said in a statement.
Each of the health insurers denied the allegations in emailed statements and said vigorous defenses are in the works.
“Aetna designed and executed its marketing programs and compensation to brokers to comply with (the Centers for Medicare & Medicaid Services) rules, and we continue to believe that we did so,” a company spokesperson said. “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.”
All of the insurers denied the claims in separate emailed responses and confirmed plans to contest the allegations.
Aetna stated that its broker compensation and marketing programs were designed to meet requirements set by the Centers for Medicare & Medicaid Services (CMS), and it maintains that those standards were followed. Elevance also said its practices continue to comply with CMS regulations.
Originally filed in 2021 under the whistleblower provisions of the False Claims Act, the lawsuit allows for triple damages if liability is proven.
The Justice Department formally intervened in January, and the case was filed on May 1. A trial date has not yet been scheduled.
