The Trump administration on Thursday filed a lawsuit against three of the country’s biggest insurance companies, accusing them of shelling out hundreds of millions “in illegal kickbacks” to insurance brokers “in exchange for enrollments into the insurers’ Medicare Advantage plans.”
What To Know
Thursday’s lawsuit was filed in Massachusetts and names Aetna Inc., Elevance Health Inc. (formerly Anthem) and Humana Inc. as defendants. It also names three insurance brokers as defendants: eHealth, Inc. and an affiliate, GoHealth Inc., and SelectQuote Inc.
Newsweek reached out to all six defendants for comment via email.
The Medicare Advantage (MA) program allows Medicare beneficiaries to enroll in private insurance companies’ MA plans. Beneficiaries often rely on insurance brokers to help them select the plan that’s best for them.
But “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,” the DOJ said.
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“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.”
A spokesperson for Humana told Newsweek in a statement: “Humana strongly disagrees with the allegations in the complaint and we look forward to vigorously defending ourselves in the legal proceedings. As always, Humana’s highest priority remains ensuring our members are provided with outstanding healthcare coverage and access to care, while also continuing to support healthcare innovation, better health outcomes, and deeper patient engagement.”
What People Are Saying
Michael Granston, the deputy assistant attorney general at the DOJ’s Civil Division, in a statement: “Health care companies that attempt to profit from kickbacks will be held accountable. We are committed to rooting out illegal practices by Medicare Advantage insurers and insurance brokers that undermine the interests of federal health care programs and the patients they serve.”
Leah Foley, the U.S. attorney for the District of Massachusetts, in a statement: “It is concerning, to say the least, that Medicare beneficiaries were allegedly steered towards plans that were not necessarily in their best interest—but rather in the best interest of the health insurance companies. The alleged efforts to drive beneficiaries away specifically because their disabilities might make them less profitable to health insurance companies are even more unconscionable. Profit and greed over beneficiary interest is something we will continue to investigate and prosecute aggressively. This office will continue to take decisive action to protect the rights of Medicare beneficiaries and vulnerable Americans.”
This is a developing story and will be updated as more information becomes available.