American public prosecutors accuse large insurers of paying bribes for private medicine plans

On Thursday, the Ministry of Justice accused three of the largest health insurers in the country of paying hundreds of millions of dollars in illegal bribes to insurance brokers that sent people in private Medicare plans.

Federal Public Prosecutors also accused two of the insurers of working with brokers to discriminate against people with disabilities by discouraging registration in private Medicare plans because the insurers thought that coverage would be more expensive.

About 12 percent of Medicare beneficiaries are younger than 65, covered by the federal insurance program because they are disabled. Their care can be expensive, given complex health needs.

According to the complaintOriginally brought by a whistleblower and accompanied by the Ministry of Justice, three of the largest health insurance companies in Land-Aetna; Health height, formerly known as anthem; and Humana – are accused of paying bribes to three large brokers, eHealth, Gohealth and Selquote, to increase the registration in their Medicare advantage plans. Those brokerage companies are also accused of misconduct.

The complaintSubmitted to a federal court in Boston, claimed that the bribe took place from at least 2016 to 2021, and to discriminate against people with disabilities.

Aetna, Elevance, GoHealth and Humana denied the allegations, while the others did not immediately respond to requests for comments.

The lawsuit is one of the first indications of the Trump administration that some Medicare Advantage plans will continue to be subject to federal control. Critics of these plans, including conference legislators, have expressed the incredibly popular policy for the use of exaggerated aggressive marketing tactics and the overloading of the federal government. Medicare Advantage plans now cover more than half of all persons registered for the federal program.

During the senate confirmation for Dr. Mehmet Oz, now the manager of the Centers for Medicare and Medicaid Services, he answered To senators who are concerned about excess in the private plans that there was a “new sheriff” in the city.

Brokers often play a central role in helping older and disabled Americans who are eligible for Medicare to decide which private plan you should choose. In the complaint, the brokers are accused of sending an individual in the plan that paid them the most instead of the one who is most suitable for the needs of that person.

In recent years, small local brokers have given way to large national organizations that have many agents and use call centers and websites, such as the companies mentioned in the suit. They now tend to trust computer programs to help brokers to identify the best plan for every caller, a technology that can make the type of control in the lawsuit easier.

Last year the BIDEN administration has one regulation Designed to reduce the reimbursements that insurers can pay for these companies to register patients, then Congress testimony And complaints from consumers that insurers grant bonuses for registering more people in certain plans, regardless of their individual needs. But a lawsuit has put the rule on hold.

When referring to cases where people with disabilities are involved, federal public prosecutors were Bot: “The alleged efforts to expel beneficiaries, specifically because their disability could make them less profitable for health insurance companies,” said American lawyer Leah B. Foley. “Profit and greed on beneficiary interest is something that we will continue to investigate and prosecute.”