The U.S. Department of Justice has filed a lawsuit against major Medicare insurers—Aetna, Elevance Health, and Humana—accusing them of paying kickbacks to brokers in exchange for steering enrollments into their Medicare Advantage plans. According to the complaint, filed in federal court, these insurers paid hundreds of millions of dollars to brokers, undermining the integrity of advice provided to Medicare beneficiaries.
Prosecutors also allege that Aetna and Humana went further, employing these financial incentives to deliberately limit the enrollment of beneficiaries with disabilities, whom the companies viewed as less profitable due to higher medical costs. The complaint specifically names prominent brokers eHealth, GoHealth, and SelectQuote, claiming the illicit activities spanned from 2016 through at least 2021.
Medicare Advantage, managed by private insurers, serves older and disabled Americans. The Justice Department’s lawsuit highlights that brokers are expected to provide impartial advice, yet allegedly favored insurers offering the highest payments, regardless of plan quality. The federal complaint includes internal communications revealing blunt discussions among executives and brokers about financial incentives and discriminatory practices.
In one cited example, a broker described Aetna’s offering in disparaging terms yet emphasized that higher payments would drive increased sales. Another instance documented an Aetna executive openly criticizing brokers for enrolling too many younger, disabled Medicare beneficiaries, actions explicitly labeled as compliance risks in internal discussions.
Humana is similarly accused of pressuring brokers to reduce the proportion of enrollees with disabilities by manipulating marketing tactics, selectively rejecting leads, and filtering incoming inquiries. Brokers faced potential payment reductions from Humana if their enrollments included too high a percentage of beneficiaries with disabilities.
All insurers and brokers named in the complaint have firmly denied wrongdoing. CVS Health, Humana, Elevance Health, eHealth, GoHealth, and SelectQuote have each declared intentions to vigorously defend against the lawsuit, labeling the allegations as baseless or unfounded.
This lawsuit emerges amid heightened scrutiny of Medicare Advantage insurers by federal regulators, partly spurred by investigative reporting by The Wall Street Journal. The Journal previously exposed similar questionable practices in the industry, including strategies employed by UnitedHealth Group to maximize government reimbursements based on inflated patient diagnoses. Newly appointed Medicare chief Mehmet Oz has vowed to tackle questionable industry practices, emphasizing accountability and transparency.
The litigation was initiated following a whistleblower complaint filed by a former employee of broker eHealth.
