DOJ Accuses Insurers Aetna, Humana, Elevance of Medicare Kickbacks

The U.S. Department of Justice has filed a lawsuit against major health insurers Aetna (CVS Health), Elevance Health (formerly Anthem), and Humana, along with leading insurance brokers eHealth, GoHealth, and SelectQuote, alleging a multi-year kickback scheme tied to Medicare Advantage plans. The suit claims that, between 2016 and 2021, these insurers paid hundreds of millions of dollars in illegal commissions to brokers to ensure seniors were steered into their plans, regardless of the beneficiaries' best interests. Prosecutors allege that brokers organized sales teams to exclusively promote plans from insurers paying the highest kickbacks and at times refused to offer plans from companies not participating in the scheme. The lawsuit also accuses Aetna and Humana of conspiring to limit enrollments of disabled beneficiaries—considered less profitable—by threatening to withhold kickbacks unless brokers diverted such patients. The complaint, filed under the False Claims Act in Massachusetts, was originally triggered by a whistleblower from eHealth. Humana and CVS have stated they disagree with the allegations and plan to defend themselves.