On May 1st the Department of Justice ("DOJ") filed a complaint against three health insurance companies and three large insurance brokerage houses under the False Claims Act, alledging that these health insurers paid hundreds of millions of dollars in kickbacks to brokers for their enrollments into the insurers Medicare Advantage plans. The insurers named in the complaint include Aetna Inc., Humana, Inc., and Elevance Health Inc. (this is Anthem) and the brokers accused are eHealth Inc., its affiliate GoHealth Inc.), and SelectQuote Inc. The payouts were made between 2016 and at least 2021 but may include additional years. 

DOJ explained in a press release that “Rather than acting as unbiased stewards, the defendant brokers allegedly directed Medicare beneficiaries to the plans offered by insurers that paid brokers the most in kickbacks, regardless of the suitability of the MA plans for the beneficiaries.” “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.”

Even more alarmingly, the DOJ alleges as a part of the complaint that Humana and Aetna conspired with the brokers to discriminate against beneficiaries with disabilities that they determined would be less profitable through allegedly threatening to withhold the kickback payments to the brokers.

The lawsuit was originally filed under whistleblower provisions under the False Claims Act, which permits the United States to intervene and take over the action.

Violations of the False Claims Act carry mandatory civil penalties per claim, and three times the amount of the government’s damages sustained due to the defendant’s actions.

Much like the corruption within the financial industry, this is simply one example of what was FOUND. Imagine how much criminality is going on that is not FOUND?