This Health Affairs Forefront piece by MPI’s Neil Patil and Carrie Graham analyzes a major federal False Claims Act lawsuit involving leading Medicare Advantage Organizations (MAOs) and large insurance brokerages. The suit alleges:
- Between 2016 and 2021, major MAOs (including Aetna, Humana, Anthem, WellCare, and Devoted Health) allegedly paid hundreds of millions of dollars to broker firms (such as eHealth, GoHealth, and SelectQuote) to drive enrollments into their plans.
- While brokers marketed themselves to consumers as “unbiased” and “carrier-agnostic,” they allegedly steered seniors toward the plans paying the highest financial incentives, regardless of whether those plans best met the beneficiaries’ needs.
- To disguise these kickbacks, the payments were labeled as reimbursements for “administrative services,” “marketing,” or customer service.
- Certain insurers pressured brokers to limit or suppress enrollments of individuals under age 65 who qualify for Medicare due to disabilities, as this population was viewed as more costly to cover.
- Brokers allegedly complied by turning away or suppressing referrals for disabled beneficiaries, violating federal anti-discrimination and enrollment rules.
The lawsuit underscores the vital role of internal whistleblowers and DOJ intervention in policing fraud within Medicare Advantage. It also brings renewed scrutiny to how broker incentives distort consumer choice, harm vulnerable populations (such as beneficiaries with disabilities), and generate substantial costs for federal healthcare programs.