The Justice Division accused three of the nation’s largest well being insurers of paying a whole lot of tens of millions of {dollars} in kickbacks to brokers in alternate for steering sufferers into the insurers’ Medicare Benefit plans.
In a criticism filed in Boston federal court docket, the DOJ alleged that CVS Well being’s Aetna, Elevance Well being and Humana engaged in an enormous kickback scheme with insurance coverage brokers eHealth, GoHealth and SelectQuote from 2016 to 2021.
The lawsuit alleges the businesses violated the False Claims Act, which prohibits submitting a false declare to the federal government for cost. The Justice Division is looking for unspecified damages and penalties.
CVS Well being, Aetna’s mother or father firm, and Humana in separate statements stated they might defend themselves vigorously. GoHealth stated the Justice Division’s case was “full of misrepresentations and inaccuracies.”
The opposite firms both had no speedy remark or didn’t reply to requests for remark.
Medicare Benefit plans are provided by non-public insurers who’re paid a set fee by the US authorities to handle healthcare for older folks on the lookout for further advantages not coated in common Medicare protection.
Many Medicare beneficiaries depend on insurance coverage brokers to assist them select insurance coverage that meet their wants and navigate the complexities of the Medicare Benefit program, the Justice Division stated.
The Justice Division stated that fairly than appearing in an unbiased method and in the most effective pursuits of sufferers, the brokers directed Medicare beneficiaries to plans provided by insurers that paid them essentially the most in kickbacks.
These kickbacks had been usually disguised and known as “marketing,” “co-op,” or “sponsorship” funds, in response to the criticism.
The lawsuit alleges the brokers incentivized their staff and brokers to promote plans based mostly on the kickbacks and at instances refused to promote the Medicare Benefit plans of insurers who didn’t pay them sufficient.
The Justice Division stated Aetna and Humana additionally threatened to withhold kickbacks to strain the brokers to enroll into their plans fewer sufferers with disabilities, who the insurers seen as much less worthwhile.
In a press release, US Lawyer Leah Foley of Massachusetts referred to as efforts to drive Medicare beneficiaries away due to their disabilities “unconscionable.”
Thursday’s case started as a whistleblower lawsuit filed in 2021 underneath the False Claims Act, which permits whistleblowers to sue firms to recuperate taxpayer funds paid out based mostly on false claims.
Such circumstances are filed underneath seal initially whereas the Justice Division investigates the claims and decides whether or not to affix the case, which it did this week.
