A blockbuster Of the Federal Ministry of Justice, it claims that insurers Aetna, Elevance Health (formerly Anthem) and Humana have paid hundreds of millions of dollars in bribes “to large insurance brokers eHealth, Gohealth and Selectquote. The payments made from 2016 to at least 2021 were incentives to send patients to the Medicare Advantage plans of the insurer, claims the court case, while the registration of potentially more expensive disabled beneficiaries is discouraged.
All insurers and brokers mentioned in the case have denied the allegations and say they will fight them in court.
Policy experts say that the lawsuit, brought on 1 May, will add fuel Long -term care About whether medicare -in -law are encouraged to select the coverage that is best for them – or the person who earns the most money for the broker.
In other Medicare news, The Wall Street Journal Last week the quoting of unnamed sources reported that a separate insurer, UnitedHealth Group, was investigated by the Ministry of Justice with regard to non -specific potential medicare -offenses. UnitedHealth pushed back, Call the article “deeply irresponsible” And say that it was not informed of such an investigation by the Doj.
Regardless of how this attention shakes, Medicare Advantage, the alternative of the private sector for the original Medicare, will probably continue to check because it covers more than half of the registered those. But the plans, which often Includes benefits that are not covered by the traditional government program, Cost of taxpayers more per registered person and have received criticism to demand patients Get prior authorization For certain services, something that is rarely required in the original Medicare requires.
The DOJ right case claims that insurers have made large payments that they called ‘marketing’ or ‘sponsorship fees to bypass rules that caps have laid down on brokerage committees. According to the court case, the payments added incentives – often more than $ 200 per registered – for brokers to lead Medicare beneficiaries to their coverage “regardless of the quality or suitability of the insurers’ plans.”
The case joins the Doj in a previously submitted whistleblowers lawsuit filed by a then employee of EHealth, Andrew Shea. The lawyer of the whistleblowers, Gregg Shapiro, said that his client is grateful that the Doj has chosen to intervene: “People with Medicare must know that when an insurance agent recommends a plan, that recommendation is based solely on the individual needs and preferences of the customer,” Shapiro said in an e -mail statement.
Although encouraged that the Trump administration has submitted the case in research initiated by the Biden administration, policy experts say that congress and insurers should do more.
“What we see in this lawsuit emphasizes the terrible stimuli that the congress desperately needs to reform,” said Brian Connell, vice president at the Leukemia & Lymphoma Society, an interest group.
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