The Ministry of Justice has accused three of the country’s largest health insurers of having paid hundreds of millions of dollars in bribes to brokers in exchange for patients in the Medicare Advantage of insurers.
In a complaint filed before the Federal Court of Boston, the DoJ allegedly alleged that CVS Health’s Aetna, Eleveance Health and Humana engaged in a vast program of bribes with the Ehealth, Gohealth and Selectquote insurance brokers from 2016 to 2021.
The trial alleges that companies have violated the law on false complaints, which prohibits the submission of a false complaint to the government for payment. The Ministry of Justice requests unpertified damage and sanctions.
CVS Health, the parent company of Aetna and Humana in separate declarations said they would defend themselves vigorously. Gohealth said the case of the Ministry of Justice was “full of false declarations and inaccuracies”.
The other companies had no immediate comments or did not respond to requests for comments.
The Advantage Medicare Plans are offered by private insurers who are paid by the US government to manage health care for the elderly looking for additional advantages not covered by ordinary health insurance coverage.
Many beneficiaries of health insurance rely on insurance brokers to help them choose insurance schemes that meet their needs and sail in the complexity of the Medicare Advantage program, said the Ministry of Justice.
The Ministry of Justice said that rather than acting impartially and in the best interests of patients, brokers led the beneficiaries of Medicare to the plans offered by the insurers who paid them most in the bribes.
According to the complaint, these bribes were often disguised and called “marketing”, “cooperative” or “godfather”.
The trial alleys that brokers prompted their employees and agents to sell plans according to bribes and have sometimes refused to sell the medicare plans for insurers who did not pay them enough.
The Ministry of Justice said that Aetna and Humana have also threatened to hold the bribes to put pressure on brokers to register for their fewer disabled patients, which insurers considered less profitable.
In a statement, the American lawyer Leah Foley of Massachusetts called for efforts to chase the beneficiaries of Medicare because of their “inadmissible” handicap.
The case of Thursday began as a denunciation trial brought in 2021 under the False Claims Act, which allows the denouncitors to continue the companies to recover the funds of taxpayers paid on the basis of false complaints.
Such cases are initially deposited under Seal while the Ministry of Justice is investigating complaints and decides to join the case, which she did this week.
