Justice Department Sues Three National Health Insurers and Three Brokers Over Alleged Medicare Advantage Kickbacks and Discrimination Against Disabled Beneficiaries
The Justice Department announced on May 1, 2025, that the United States had filed a complaint under the False Claims Act in federal court in Boston, Suffolk County, Massachusetts, against three of the nation's largest health insurance companies and three large insurance broker organizations.
The defendant insurers are Aetna Inc. and affiliates, Elevance Health Inc. (formerly known as Anthem), and Humana Inc.; the defendant brokers are eHealth, Inc. and an affiliate, GoHealth, Inc., and SelectQuote Inc. The United States alleges that from 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 offered by private insurance companies such as Aetna, Anthem and Humana, the Justice Department said. Many beneficiaries rely on insurance brokers to help them choose a plan that best meets their needs. Rather than acting as unbiased stewards, the defendant brokers allegedly directed beneficiaries to the plans offered by insurers that paid brokers the most in kickbacks, regardless of the suitability of the plans. According to the complaint, the broker organizations incentivized their employees and agents to sell plans based on the insurers' kickbacks, set up teams of agents who could sell only those plans, and at times refused to sell plans of insurers that 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 allegedly did so by threatening to withhold kickbacks to pressure brokers to enroll fewer disabled beneficiaries in their plans. In response, the brokers or their agents allegedly rejected referrals of disabled beneficiaries and strategically directed disabled beneficiaries away from Aetna and Humana plans.
"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." U.S. Attorney Leah B. Foley for the District of Massachusetts said it was concerning that beneficiaries were allegedly steered toward plans not necessarily in their best interest but in the insurers', and called the alleged efforts to drive beneficiaries away because their disabilities might make them less profitable "even more unconscionable," adding that her office would continue to investigate and prosecute such conduct aggressively and protect Medicare beneficiaries and vulnerable Americans.
The lawsuit was originally filed under the qui tam, or whistleblower, provisions of the False Claims Act, under which private parties can file an action on behalf of the United States and receive a portion of any recovery, and the United States may intervene and take over the action, as it has done here. If a defendant is found liable, the United States may recover three times its losses plus applicable penalties. 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 Office of Inspector General and the FBI. The case is captioned United States ex rel. Shea v. eHealth, et al., No. 21-cv-11777. The claims asserted in the complaint are allegations only; there has been no determination of liability. (Source: U.S. Department of Justice)
Source: U.S. Department of Justice
Published by GSM · USA (original Chinese edition)
Photo: 图：位于马萨诸塞州波士顿（Boston）的 John Joseph Moakley 美国联邦法院大楼（资料图），本案诉状即向该院所在的马萨诸塞联邦地区法院提起。Beyond My Ken 摄，CC BY-SA 4.0，经 Wikimedia Commons。 / Photo: The John Joseph Moakley United States Courthouse in Boston, Massachusetts (file photo), home of the U.S. District Court for the District of Massachusetts, where the complaint was filed. Beyond My Ken, CC BY-SA 4.0, via Wikimedia Commons.
