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Uncovering Bias and Kickbacks: DOJ Targets Major Insurers and Brokers in Medicare Advantage Case
- Jeffrey Lynne
- Jul 7
- 2 min read
On May 1, 2025, the Department of Justice filed a landmark False Claims Act lawsuit in federal court in Boston against three of the country’s largest health insurers—Aetna (CVS Health), Elevance Health (formerly Anthem), and Humana—alongside three top Medicare brokerages—eHealth (and its affiliate), GoHealth, and SelectQuote
🚨 The Allegations
Illegal Kickbacks to BrokersFrom 2016 through at least 2021, the insurers allegedly paid hundreds of millions in disguised “marketing,” “co‑op,” or “sponsorship” fees to brokerages—in return for steering seniors into their Medicare Advantage (MA) plans These payments allegedly induced brokers to promote plans that enriched insurers, rather than those best tailored to beneficiaries
Steering Disabled Enrollees The DOJ further alleges that Aetna and Humana pressured brokers—by threatening to withhold kickbacks—to avoid enrolling people with disabilities, whom they perceived to be less profitable, amounting to discrimination against one of Medicare’s most vulnerable populations
Violation of the False Claims Act schemes purportedly led to false or fraudulent claims for capitation payments under MA plans. The DOJ now seeks treble damages, civil penalties, and injunctive relief under the FCA
Voices from the Front
DOJ Civil Division emphasized that “health care companies that attempt to profit from kickbacks will be held accountable.”
U.S. Attorney Leah Foley (District of Massachusetts) described the preferential steering of non-disabled participants as “even more unconscionable.”
Responses and Fallout
The insurers have announced their intention to defend vigorously, while brokers like GoHealth and eHealth have dismissed the charges as “flawed” or “meritles.s”
Why This Matters
Integrity of Medicare Advantage: The MA program now covers more than half of all U.S. seniors. This case sheds light on concerning practices by insurers and brokers that may compromise patient care, inflate costs, and reduce trust in the system
Implications for Compliance and Enforcement: This action signals a sharpening government focus on kickback schemes and discriminatory enrollment practices. Health plans and brokers should reassess their incentive structures and monitoring protocols.
Broad FCA Enforcement Trends: Part of a larger wave of recent healthcare fraud actions—including multi‑billion dollar takedowns and DME‑billing investigations—this case reinforces DOJ’s aggressive posture
What This Means for Clients
At Lynne Legal, we remain available to:
Provide compliance audits of broker compensation models;
Develop proactive protocols to prevent kickback and anti-discrimination violations;
Advise clients on handling government investigations and FCA litigation.
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