DOJ sues insurers, brokers for patient steering toward MA plans 

WASHINGTON – The U.S. Department of Justice has filed a complaint against three of the nation’s largest health insurance companies for allegedly paying hundreds of millions of dollars in illegal kickbacks to broker organizations in exchange for enrollment in their Medicare Advantage plans. 

The complaint, filed under the whistleblower provisions of the False Claims Act, names Aetna and affiliates, Elevance Health (formerly known as Anthem) and Humana, as well as brokers eHealth and affiliate, GoHealth and SelectQuote. 

“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. “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 filed the complaint on May 1 in U.S. District Court in Massachusetts. 

According to the complaint: 

• The brokers allegedly directed Medicare beneficiaries to MA plans offered by insurers that paid brokers the most in kickbacks, regardless of the suitability of the MA plans for the beneficiaries. The brokers allegedly incentivized their employees and agents to sell plans based on the insurers’ kickbacks, set up teams of insurance agents who could sell only those plans, and at times refused to sell MA plans of insurers who did not pay sufficient kickbacks. 
• Aetna and Humana each allegedly conspired with the brokers to discriminate against Medicare beneficiaries with disabilities whom they perceived to be less profitable. They did so by allegedly threatening to withhold kickbacks to pressure brokers to enroll fewer disabled Medicare beneficiaries in their plans. In response to these financial incentives, the brokers allegedly rejected referrals of disabled beneficiaries and strategically directed disabled beneficiaries away from Aetna and Humana plans. 

“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. “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.” 

The Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the District of Massachusetts are handling the matter, with assistance from the Department of Health and Human Services (HHS) Office of Inspector General and the FBI.