🚨 Major Insurers and Brokers Accused of Medicare Kickback Scheme and Discrimination

May 1, 2025 — A new federal lawsuit has sent shockwaves through the Medicare insurance industry. According to a complaint filed by the U.S. Department of Justice in the District of Massachusetts, several of the nation’s largest Medicare Advantage insurers and major call centers, have been accused of engaging in illegal kickbacks and discriminating against disabled Medicare beneficiaries.

At the center of the case: Aetna (CVS Health), Humana, and Elevance Health (formerly Anthem)—alongside top broker/call centers: eHealth, GoHealth, and SelectQuote.

What the Lawsuit Alleges

The lawsuit, United States v. eHealth, et al. (Case No. 21-cv-11777-DJC), details an extensive scheme allegedly active from 2016 through at least 2021, in which:

1. Illegal Kickbacks Were Paid to Brokers

Insurers allegedly funneled hundreds of millions of dollars to brokers as so-called “marketing” or “co-op” payments, which in reality were performance-based kickbacks. These payments were not disclosed to consumers and were structured to steer beneficiaries into plans that benefited insurers, regardless of the beneficiary's actual needs.

Actual text from the lawsuit:
“Defendants hid the true nature of agreements behind contracts and invoices that purported to cover only the cost of marketing or administrative services. All the while, Defendants knew what they were doing was illegal.

For example, when discussing a purported “marketing” agreement with Humana, one eHealth executive joked that Humana was paying eHealth “$15M/year for a [web]site that drives 15 enrollments per year. CMS will surely never figure that one out. . . . Luckily the govt are generally morons.”

Meanwhile, when discussing Aetna’s sham agreements, another eHealth executive wrote that the “marketing” payment model was “not even a little compliant. . . . I’m pretty sure if Aetna got audited by cms, they’d be fu[**]ed.” And though Anthem kept the true purpose of its “marketing” payments out of its contracts with brokers, Anthem executives often referenced the “underlying business agreement” of money for sales.

Brokers, who claimed to be unbiased, are accused of:

• Limiting plan options shown to consumers,
• Using call routing systems to favor high-paying insurers,
• Creating exclusive teams of agents who only sold one insurer’s plans.

2. Discrimination Against Disabled Beneficiaries

Perhaps even more disturbing, Humana and Aetna allegedly worked with brokers to reduce enrollments of beneficiaries with disabilities, whom they considered more expensive to insure.

Internal communications revealed brokers were instructed to:

• Filter out callers under age 65 (typically Medicare-eligible due to disability),
• Suppress ads in areas with higher disabled populations,
• Use tracking codes like “U65” to monitor and minimize disabled enrollment.

This violates federal law, which prohibits Medicare Advantage plans from discriminating based on health status or disability.

3. False Claims Act Violations

Because these activities were tied to taxpayer-funded Medicare Advantage plans, the U.S. government alleges the parties submitted or caused the submission of false claims to CMS, in violation of the False Claims Act. These claims falsely certified compliance with the Anti-Kickback Statute (AKS) and anti-discrimination laws.

Each violation could carry significant financial penalties and require repayment of improperly obtained Medicare funds.

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Why This Matters

At the Senior Savings Network, we have always advocated for clear, ethical guidance for those navigating Medicare. These allegations—if proven true—underscore the importance of working with trusted, truly independent advisors who prioritize the beneficiary’s needs, not insurer bonuses.

Medicare is complex enough without deceptive sales practices. Every senior deserves unbiased help choosing a plan that fits their health needs and budget.

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Resources Cited

1. United States v. eHealth, et al., Complaint in U.S. District Court, District of Massachusetts, No. 21-cv-11777-DJC
2. False Claims Act (31 U.S.C. §§ 3729–3733)
3. Anti-Kickback Statute (42 U.S.C. § 1320a–7b)
4. CMS Broker Compensation Rules (42 C.F.R. § 422.2274)
5. CMS Anti-Discrimination Regulations (45 C.F.R. § 92.207, 42 U.S.C. § 18116)
6. Medicare Advantage Program Statutes (42 U.S.C. §§ 1395w-21–1395w-28)
7. Federal Register Notices (e.g., 73 Fed. Reg. 28556, 86 Fed. Reg. 5864)