DOJ sues Aetna, Humana and Elevance for allegedly paying illegal kickbacks
The U.S. Department of Justice (DOJ) accused three of the largest health insurance companies of providing brokers with “unlawful kickbacks,” in violation of the False Claims Act.
According to an announcement, prosecutors said they filed a formal complaint in federal court on Monday, accusing CVS Health’s Aetna, Elevance Health and Humana of paying “hundreds of millions of dollars” in incentives to brokers for enrolling seniors in Medicare Advantage plans.
According to the DOJ, this happened between 2016 and 2021, and the insurers paid “regardless of the suitability of the Medicare Advantage plans for the beneficiaries.”
Further, the agency alleged that Aetna and Humana each “conspired” with their associated brokers to “discriminate against Medicare beneficiaries with disabilities,” as signing them up as members would be less profitable.
“Aetna and Humana allegedly did so by threatening to withhold kickbacks to pressure brokers to enroll fewer disabled Medicare beneficiaries in their plans,” the DOJ claimed, adding that all parties would direct disabled seniors away from Medicare Advantage coverage if they expressed interest in signing up.
“It is concerning, to say the least, that Medicare beneficiaries were allegedly steered towards plans that were not necessarily in their best interest—but rather in the best interest of the health insurance companies,” U.S. Attorney Leah B. Foley for the District of Massachusetts, said in a statement. “The alleged efforts to drive beneficiaries away specifically because their disabilities might make them less profitable to health insurance companies are even more unconscionable.”
Federal prosecutors added that brokers were complicit in the scheme and would often not submit applications to enroll people in Medicare Advantage if the kickbacks were not deemed sufficient.
The lawsuit stemmed from an unnamed whistleblower complaint, the DOJ said. Under provisions of the False Claims Act, private parties may file complaints on behalf of the U.S. and receive a portion of any funds recovered, should the complaint be validated and the DOJ either win its case in court or reach a settlement
HealthExec reached out to Humana, Aetna and Elevance for comment. In other statements sent to the media, Humana and CVS Health’s Aetna said they are still reviewing the complaint.
It’s unclear if and when the DOJ’s case will move forward.
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