Humana, Elevance, Aetna Face DOJ Lawsuit Over Illegal Kickback Scheme, Discrimination Against Disabled People

The U.S. Department of Justice filed a lawsuit last Thursday against three of the country's largest health insurers: Elevance Health, Inc. ELV, Humana, Inc. HUM and Aetna, Inc. 

The lawsuit alleges that from 2016 through at least 2021, the insurers paid hundreds of millions of dollars in illegal kickbacks to brokers in exchange for enrolling Medicare beneficiaries into their Medicare Advantage (MA) plans.

The Details: According to the complaint, instead of helping beneficiaries choose the most suitable MA plan, brokers, — eHealth, Inc., GoHealth, Inc. and SelectQuote Inc. — steered clients toward the plans offered by insurers that paid the highest kickbacks, regardless of the plans' quality or fit for the beneficiaries' needs. 

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The brokers, who were also charged, allegedly incentivized their agents to prioritize these plans, created teams focused solely on selling them and refused to offer plans from insurers that did not provide sufficient kickbacks.

The DOJ also claimed that Aetna and Humana conspired with the brokers to discriminate against Medicare beneficiaries with disabilities, whom they viewed as less profitable. 

The insurers allegedly threatened to withhold kickbacks to pressure brokers to enroll fewer disabled beneficiaries in their plans. In response, brokers and their agents reportedly rejected referrals and directed disabled beneficiaries away from Aetna and Humana plans.

The Justice Department is seeking damages and penalties for the alleged violations of the Anti-Kickback Statute and the False Claims Act. 

All companies in the lawsuit denied the allegations and stated their intent to defend themselves.

A spokesperson for Humana told Newsweek in a statement: “Humana strongly disagrees with the allegations in the complaint and we look forward to vigorously defending ourselves in the legal proceedings. As always, Humana’s highest priority remains ensuring our members are provided with outstanding healthcare coverage and access to care, while also continuing to support healthcare innovation, better health outcomes, and deeper patient engagement.”

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