On May 1, a whistleblower filed a complaint under the federal False Claims Act (FCA) against Aetna, Elevance Health (formerly Anthem) and Humana alleging that the insurers paid hundreds of millions of dollars in illegal kickbacks to induce brokers including GoHealth, eHealth and SelectQuote (the “Brokers”) to steer beneficiaries to their Medicare Advantage plans. While the Brokers claimed to be unbiased and carrier-agnostic in public statements, the complaint alleges that the Brokers repeatedly directed Medicare beneficiaries to plans that offered the Brokers the most money, regardless of the quality or suitability of the plan.
The complaint also alleges that Humana and Aetna violated federal law that bars insurers from favoring the enrollment of healthier beneficiaries, and that the insurers discriminated against Medicare beneficiaries with disabilities who might be less profitable. As a result of the financial inducements from Aetna and Humana, the Brokers rejected referrals of disabled beneficiaries, filtered phone calls from disabled beneficiaries, and directed them away from Aetna and Humana plans.
Rivkin Radler attorneys will continue to monitor this case as it develops.
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