BOSTON – The United States has filed a complaint against three of the nation’s largest health insurance companies: Aetna, Inc. and affiliates; Elevance Health, Inc. (formerly known as Anthem); and Humana Inc., and three large insurance broker organizations: eHealth, Inc. and an affiliate; GoHealth, Inc.; and SelectQuote, Inc.
The United States alleges that from at least 2016 through at least 2021, the defendant insurers paid hundreds of millions of dollars in illegal kickbacks to the defendant brokers in exchange for enrollments into the insurers’ Medicare Advantage plans.
Under the Medicare Advantage (MA) Program, also known as Medicare Part C, Medicare beneficiaries may choose to enroll in health care plans (MA plans) offered by private insurance companies, such as defendants Aetna, Anthem and Humana. Many Medicare beneficiaries rely on insurance brokers to help them choose an MA plan that best meets their individual needs.
According to the complaint, the broker organizations 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.
The United States further alleges that Aetna and Humana each conspired with the broker defendants to discriminate against Medicare beneficiaries with disabilities whom they perceived to be less profitable. Aetna and Humana did so by allegedly threatening to withhold kickbacks to pressure brokers to enroll fewer disabled Medicare beneficiaries in their 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. 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,” said United States Attorney Leah B. Foley.
“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 lawsuit was originally filed under the qui tam or whistleblower provisions of the False Claims Act (FCA). Under the FCA, private parties can file an action on behalf of the United States and receive a portion of the recovery. The FCA permits the United States to intervene in and take over the action, as it has done here. If a defendant is found liable for violating the FCA, the United States may recover three times the amount of its losses plus applicable penalties.
Defendant: Aetna, Inc. and affiliates, Elevance Health, Inc., and Humana Inc.
Criminal Charges: Unlawful kickbacks and disability discrimination under the Medicare Advantage Program.
City and State: Boston, Massachusetts.
Exact Date: At least 2016 through at least 2021.
Sentence or Outcome: Currently pending.
Dollar Amount: Hundreds of millions of dollars.
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Key Facts
- State: Massachusetts
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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