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U.S. Sues Major Insurers and Brokers Over Medicare Advantage Kickback Scheme

The lawsuit alleges illegal payments and discriminatory practices targeting disabled beneficiaries, seeking treble damages under the False Claims Act.

This Thursday, June 1, 2017, photo, shows a sign on the campus of the Aetna headquarters, in Hartford, Conn.
Signage for Humana Inc. is pictured at a health facility in Queens, New York City, U.S., November 30, 2021. REUTERS/Andrew Kelly

Overview

  • The U.S. government has filed a False Claims Act lawsuit against Aetna, Elevance Health, Humana, and three broker organizations: eHealth, GoHealth, and SelectQuote.
  • The complaint accuses the defendants of paying hundreds of millions in illegal kickbacks between 2016 and 2021 to drive Medicare Advantage enrollments.
  • Brokers allegedly prioritized insurers offering the highest kickbacks, steering beneficiaries to unsuitable plans and discriminating against disabled enrollees.
  • Aetna and Humana are accused of conspiring with brokers to discourage enrollments of disabled beneficiaries, whom they deemed less profitable.
  • The case, originally filed under the FCA’s whistleblower provisions, is now led by the DOJ, with potential penalties of triple damages if liability is determined.