The United States Ministry of Justice (DOJ) filed a complaint Thursday against three Medicare Advantage insurers and three organizations of insurance brokers, alleging that insurers had paid illegal bribes to brokers to increase registration for their plans.
Insurers appointed to the complaint are Aetna, Elevance Health and Humana, while the brokers are Ehealth, Gohealth and Selectquote. The DoJ allegedly allegedly allegedly from 2016 to 2021, insurers paid hundreds of millions of dollars in bribes to brokers. Baskets are illegal payments in exchange for favorable treatment. The complaint was filed with the US District Court of the Massachusetts district under the law on false complaints.
To choose a Medicare Plan Advantage, many elderly people count on brokers to help find the option that best meets their needs. However, the DOJ maintains that some brokers can orient the elderly to the plans of insurers offering the largest bribes, rather than those who are most suitable for the individual.
The complaint said that the defendant brokers encouraged employees and agents to sell insurers’ plans with the most bribes, and that they would sometimes refuse to sell MA plans with insurers who did not pay enough in bribes.
“The health care companies trying to take advantage of the bribes will be held responsible,” said deputy deputy prosecutor Michael Granston of the civil division of the Ministry of Justice in a statement. “We are committed to eliminating illegal practices by insurers and insurance brokers from Medicare Advantage who undermine the interests of federal health care programs and the patients they serve.”
The DoJ also alleged that and Etna and Humana were working with defendant brokers to discriminate the beneficiaries of a disabled medication which they considered less profitable. They did so by threatening to retain the bribes so that the brokers register less disabled beneficiaries in these plans and direct them to other plans, according to the complaint.
“It is worrying, at the very least, that the beneficiaries of Medicare would have been directed to plans which were not necessarily in their best interest – but rather in the best interest of health insurance companies,” said US prosecutor Leah B. Foley for the Massachusetts district, in a press release. “The alleged efforts to distance beneficiaries specifically because their handicap could make them less profitable for health insurance companies is even more unacceptable.”
Several of the accused postponed the complaint. An Elevance Health spokesperson said the company is convinced that its health plans “conforms and continue to comply” “the rules and directives described by the centers for Medicare and Medicaid Services (CMS) and will fight against allegations.
Likewise, an Aetna spokesperson said that the insurer had designed and executed his marketing programs and his compensation to brokers to comply with the CMS.
“We remain determined to provide high quality insurance products for various individual needs and we strive to ensure that each individual is in the best plan for their needs. We dispute the allegations and intend to defend ourselves vigorously, “said Phillip Blando, spokesperson for the Aetna.
A Humana spokesman also said that the insurer did not agree with the allegations and would defend himself in legal proceedings. The spokesperson added that the “highest priority of Humana remains to ensure that our members are provided with exceptional health coverage and access to care”.
The brokers also challenged the allegations, a spokesperson for Selectquote saying that the company has always been a high integrity organization that has respected all the applicable rules and regulations. We put the best interests of customers at the forefront of what we do and think that these claims are baseless. ”
In a press release, Ehealth noted that the company had completely cooperated with the Doj since its notification of its investigation in 2022.
“Ehealth firmly believes that the assertions are without merit and remain determined to defend itself vigorously,” said the company.
Gohealth did not immediately return a comment request.
Photo: Gearstd, Getty Images
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