The United States has filed a complaint against Aetna, Elevance and Humana for allegedly paying millions of dollars in kickbacks to insurance brokers eHealth, GoHealth and SelectQuote.
The brokers allegedly directed Medicare beneficiaries to the plans that paid them the most in kickbacks, regardless of the suitability of the plans for the beneficiaries, according to the Department of Justice.
From 2016 through at least 2021, the insurers allegedly paid hundreds of millions of dollars to the brokers. The kickbacks were often disguised and referred to as "marketing," "co-op," or "sponsorship" payments, 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 complaint said.
However, the brokers were financially discouraged from enrolling disabled seniors into Aetna and Humana plans, the complaint said, because these beneficiaries were viewed as being less profitable.
WHY THIS MATTERS
The United States is asking for civil penalties and a jury trial in the complaint brought in federal court in Massachusetts, according to information released Thursday by the DOJ.
The complaint was originally brought by a whistleblower, who would be expected to share in any potential monetary damages.
The claims asserted in the complaint are allegations only. There has been no determination of liability.
THE LARGER TREND
Many Medicare beneficiaries rely on insurance brokers to help them choose an MA plan that best meets their individual needs.
"These insurance brokers wield considerable influence over our nation's most vulnerable citizens as they choose from many different health plan options – a decision that can have significant health and financial consequences," the complaint said. "For that reason, Congress expressly called for regulations that create incentives for brokers to 'enroll individuals in the Medicare Advantage plan that is intended to best meet their healthcare needs.'"
Email the writer: SMorse@himss.org