Editor's note: This story has been updated with a statement from SelectQuote.
The Trump administration has filed a complaint against three major payers and three broker organizations, claiming the insurers paid kickbacks to brokers to boost Medicare Advantage (MA) enrollment.
Insurers Aetna, Humana and Elevance Health are named, as are eHealth, GoHealth and SelectQuote. The Department of Justice (DOJ) said that between 2016 and 2021, those three brokers were paid "hundreds of millions" in kickbacks in exchange for enrolling people in the insurers' MA plans.
Many seniors use brokers to enroll in Medicare plans, as they can help these individuals better navigate the process. However, the lawsuit alleges that patients were steered to the plans that paid the highest kickback sums.
The complaint was filed Thursday in Massachusetts district court under the False Claims Act, according to a press release from the DOJ.
Per the filing, the brokers set up teams that would sell only the plans that paid out high kickbacks and would refuse to sell those from insurers that did not make such payments.
The DOJ alleged that Aetna and Humana threatened they would withhold kickbacks to these brokers to encourage them to enroll fewer beneficiaries with disabilities in their plans. The lawsuit charges that the defendant brokers steered disabled patients away from Aetna and Humana plans to secure the payouts.
“Health care companies that attempt to profit from kickbacks will be held accountable,” Deputy Assistant Attorney General Michael Granston, of the department’s civil division, said in the press release. “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.”
CVS Health, Aetna's parent company, said it intends to "defend ourselves vigorously" against the charges in the complaint.
"Aetna designed and executed its marketing programs and compensation to brokers to comply with CMS rules, and we continue to believe that we did so," cVS said. "We remain committed to providing high quality insurance products for diverse individual needs and strive to ensure that each individual is in the best plan for their needs."
Humana responded similarly to the lawsuit in a statement.
“Humana strongly disagrees with the allegations in the complaint and we look forward to vigorously defending ourselves in the legal proceedings," the company said in a statement. "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.”
Elevance Health also said in a statement that it intends to "vigorously fight the allegations in the complaint."
"Elevance Health and its affiliated health plans are committed to delivering high-quality healthcare services," the company said. "We are confident that our health plans have complied with and continue to comply with the Centers for Medicare & Medicaid Services, marketing and broker compensation regulations, rules and guidelines.
In a statement, broker GoHealth said it "has always operated in a manner that is compliant with all rules and regulations."
"We are disappointed with their decision to intervene and disagree with their accusations, which are full of misrepresentations and inaccuracies," the broker said. "We intend to vigorously defend against these allegations, and we will not allow this litigation to distract from our mission to provide peace of mind to the Medicare beneficiaries that we serve."
Broker eHealth echoed the sentiment in its own statement.
"“Since being notified of the government’s investigation in January 2022, eHealth has fully cooperated with the Department of Justice to demonstrate that we conduct our business affairs consistent with federal regulations," eHealth said. "eHealth strongly believes the claims are meritless and remains committed to vigorously defending itself.
In a statement, SelectQuote said that broker has "put the best interests of the customers at the forefront of what we do and believe these claims are baseless."
"SelectQuote has been in business for over 40 years and has helped millions of Americans find the right coverage for their needs," the statement said. "We have always been a high-integrity organization that has abided by all applicable rules and regulations."
The DOJ said the filing highlights its focus on rooting out fraud.