By Anna Wilde Mathews, Christopher Weaver and Katherine Hamilton
The Justice Department filed a complaint alleging some of the biggest Medicare insurers paid kickbacks to brokers that sell such plans, seeking to grab market share and in some cases avoid enrollees with disabilities who might come with heavy health costs.
Prosecutors say in the complaint filed Thursday, that CVS Health’s CVS -3.28%decrease; red down pointing triangle Aetna, Elevance Health ELV 0.49%increase; green up pointing triangle and Humana HUM 0.96%increase; green up pointing triangle paid hundreds of millions of dollars to get the brokers to steer customers into the insurers’ Medicare Advantage plans.
Aetna and Humana also used payments to “pressure brokers to enroll fewer Medicare beneficiaries with disabilities, whom the insurers perceived as more expensive to cover,” and thus less profitable, according to the complaint.
The brokers named in the complaint are eHealth EHTH -2.88%decrease; red down pointing triangle, GoHealth GOCO -4.66%decrease; red down pointing triangle and SelectQuote.
The complaint said the alleged transactions occurred from 2016 through at least 2021. The federal prosecutors are joining previously-sealed litigation filed by a whistleblower who is a former eHealth employee.
CVS Health and Humana both said they disagree with the allegations and plan to defend themselves vigorously. GoHealth said it has always complied with regulations and said the accusations against it include misrepresentations.
EHealth said it believes the complaint’s “claims are meritless.” Elevance Health said it was confident its plans have complied, and continue to comply with federal rules around broker payments, and it will fight the allegations.
SelectQuote had no immediate comment.
Under Medicare Advantage, private insurers administer the benefits of the federal health-coverage program for older and disabled Americans. Patients often work with insurance brokers to choose a plan.
The program is a huge business for big insurers, and it has grown rapidly. Medicare Advantage insurers now cover more than half of all Medicare enrollees.
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