DOJ sues Humana, Aetna, Elevance, and brokers over alleged Medicare Advantage kickbacks

The US Department of Justice (DOJ) is going after the country’s largest Medicare Advantage (MA) providers and brokers.

On May 1, the DOJ filed a complaint in the US District Court of Massachusetts alleging Humana, Aetna, and Elevance Health (formerly Anthem) paid hundreds of millions of dollars in illegal kickbacks to brokers eHealth, eHealth affiliate GoHealth, and SelectQuote from 2016 through at least 2021.

In exchange, the brokers “repeatedly directed Medicare beneficiaries to the plans offered by insurers that paid them the most money, regardless of the quality or suitability of the insurers’ plans,” despite publicly claiming they were not biased toward any plans or carriers, according to the DOJ’s filing.

The brokers allegedly “incentivized their agents to sell those plans; set up teams of agents who could sell only those plans; and at times ‘shut off,’ or refused to sell, plans of insurers who did not pay or did not pay enough in kickbacks,” the filing alleged.

One broker executive allegedly told Aetna “more money will help drive more sales [be]cause your product is dog sh[*]t.”

Alleged discrimination. The DOJ alleged Aetna and Humana also illegally discriminated against people with disabilities by paying brokers kickbacks to enroll fewer in their MA plans.

“The defendant brokers rejected referrals of disabled beneficiaries, filtered telephone calls from disabled beneficiaries, and strategically directed disabled beneficiaries away from Aetna and Humana plans,” the allegations read.

The DOJ is seeking to recover monetary damages under the False Claims Act, alleging these brokers and companies violated the Anti-Kickback Statute, which makes it illegal to pay or receive rewards for referring customers to federal healthcare programs. The government also wants a civil monetary penalty “for each false or fraudulent claim.”

In statements to Healthcare Brew, SelectQuote, Humana, Aetna, and Elevance spokespeople rejected the accusations, contending that their businesses complied with all Centers for Medicare and Medicaid Services rules. They all expressed plans to “vigorously” fight the allegations.

Healthcare Brew also reached out to eHealth and GoHealth, and will update this article with their comments if they respond after publication.