The US Department of Justice.
The appointed insurers on the complaint are Aetna, Elevance Health and human, while the runners are Ehealth, Gohealth and Selectquote. The Department of Justice claimed that from 2016 to at least 2021, insurers paid hundreds of millions of dollars in bribes to the runners. Bribes are illegal payments in exchange for favorable treatment. The complaint was filed in the United States District Court for the Massachusetts district under the law of false claims.
To choose a Medicare advantage plan, many older people trust runners to help find the option that best meets their needs. However, the Department of Justice argues that some runners can lead the elderly towards the plans of the insurers offered by the greatest bribes, instead of the most appropriate for the individual.
The complaint declared that the accused corridors encouraged employees and agents to sell insurers plans with the greatest amount of bribes, and sometimes they would refuse to sell ma plans that did not pay enough in bribes.
“The medical care companies trying to obtain bribery profits will be responsible for the hero,” said Deputy Attorney General Michael Granston of the civil division of the Department of Justice in a statement. “We are committed to eliminating illegal practices by the insurers of Medicare Advantage and insurance corridors that do not spend the interests of federal medical care programs and the patients they serve.”
The Department of Justice also claimed that Aetna and Humanana worked with the defendants to discriminate against the beneficiaries of Medicare with disabilities that are consulted that are less profitable. They did this threatening to retain bribes so that the runners would make the beneficiaries of Androll Ferwer with disabilities in those plans and directed them to other plans, according to the complaint.
“It is a group, to say the least, that Medicare beneficiaries were supposedly directed towards plans that were not necessarily in their best interest, but rather in the best interest of health insurance companies,” said the US prosecutor of the Foleyts. “The supposed efforts to promote beneficiaries specifically because their disabilities could be less profitable for health insurance companies are equally more inconceivable.”
Several of the defendant retreated the complaint. A spokesman for Elevance Health said that the company is confident that its health plans have “complied with and continue to comply” with the rules and guidelines described by the Medicare and Medicaid service centers (CMS) and will fight with the accusations.
Similarly, an AETNA spokesman said the insurer designed and executed her marketing and compensation programs for runners to meet CMS.
“We are still committed to providing high quality insurance products for various individual needs and we strive to ensure that each individual is in the best plan for their needs. We play the accusations and we intend to defend ourselves vigorously, “said Phillip Soft, spokesman for Aetna.
A human spokesman also said that the insurer does not agree with the accusations and will defend ITELF in legal procedures. The spokesman added that the “highest human priority is still ensuring that our members receive an outstanding health coverage and access to care.”
The runners also questioned the accusations, with a selectquote spokesman who says that the company “has always been a high integrity organization that has suffered all applicable rules and regulations. We put the best deer and the love of customers at the point of view without foundation.”
In a statement, Ehealth said that the company has fully cooperated with the Department of Justice since it was notified of investigation in 2022.
“Ehealth firmly believes that the statements have no merit and remain committed to defending themselves vigorously,” said the company.
Gohealth did not immediately return a request to comment.
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