DOJ sues Aetna, other major MA insurers over alleged kickbacks

The Department of Justice recently filed a complaint against three major Medicare Advantage insurers, alleging hundreds of millions of dollars in illegal kickbacks to brokers in exchange for enrollment in their plans.

The insurers cited in the complaint are Aetna Inc. and affiliates, Elevance Health Inc. (formerly Anthem) and Humana Inc. Three large insurance broker organizations were also included in the complaint. They are eHealth, Inc., GoHealth, Inc. and SelectQuote Inc.

The complaint states that the Medicare Advantage, or MA, insurers paid illegal kickbacks to the brokers from 2016 to at least 2021. Subsequently, the brokers incentivized their employees and agents to sell MA plans to enrollees based on the kickbacks, according to the complaint. They also allegedly established teams of insurance agents who would only sell the plans from the accused MA insurers. These teams supposedly, at times, refrained from selling MA plans of insurers who did not engage in kickbacks.

Further, the complaint accuses Aetna and Humana of conspiring with the defendant brokers to discriminate against Medicare beneficiaries with disabilities. The Department of Justice said the insurers viewed these beneficiaries as “less profitable,” so they threatened to withhold kickbacks to brokers to incentivize them to enroll fewer disabled beneficiaries.

As a result, the brokers allegedly rejected referrals of disabled Medicare beneficiaries and directed them away from Aetna and Humana plans.

MA enrollees use brokers to help them choose a plan. These brokers are supposed to be unbiased, assisting enrollees in identifying the best MA plan for their individual needs. However, brokers are paid by MA insurers to offer their plans to Medicare beneficiaries. They typically receive commission from the payers for each enrollment they facilitate.

Nearly one-third of all new Medicare enrollees use brokers or agents to choose an MA plan, according to a report from the Commonwealth Fund.

"Health care companies that attempt to profit from kickbacks will be held accountable," Deputy Assistant Attorney General Michael Granston of the Justice Department’s Civil Division said in a statement. "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."

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.