A federal judge has ruled that a high-profile lawsuit involving major insurers—including Aetna, Elevance Health, and Humana—can move forward, rejecting efforts to dismiss allegations of improper broker payments tied to Medicare Advantage plans.
The case, brought by the U.S. Department of Justice, builds on a whistleblower complaint and claims that insurers paid brokers substantial sums to steer beneficiaries toward their plans between 2016 and 2021. The lawsuit also includes brokers such as GoHealth, SelectQuote, and eHealth, all of which will continue to face litigation.
In addition to kickback allegations, the suit raises concerns about potential discrimination, claiming that certain payment structures may have discouraged enrollment of beneficiaries with disabilities. While the judge allowed these core claims to proceed, an unjust enrichment claim was dismissed, with the court noting that the False Claims Act provides a sufficient legal pathway for recovery.
The ruling comes amid increased federal scrutiny of Medicare Advantage marketing practices, signaling ongoing regulatory and legal pressure on payer-broker relationships. For healthcare organizations, this case highlights the importance of compliance and transparency in third-party marketing and enrollment strategies as enforcement activity continues to evolve.
Resource: Judge rules Aetna, Elevance, Humana must face Medicare kickback allegations