A successful trial From the Federal Ministry of Justice alleys that insurers Aetna, Elevance Health (formerly Anthem) and Humana paid “hundreds of millions of dollars in bribes” to large insurance brokerage houses, Gohealth and Selectquote. Payments, made from 2016 to at least 2021, were incentives to prohibit patients in the medicare plans of the insurer, according to the trial, while discouraging the registration of potentially more expensive disabled beneficiaries.
All insurers and brokers appointed in the case have denied allegations and say they will fight them in court.
Political experts say that the trial, tabled on May 1, will add fuel long -standing concerns On the question of whether Medicare registrants are encouraged to select the coverage that suits them best – or the one that earns the most money for the broker.
In other news from Medicare, The Wall Street Journal Last week, citing anonymous sources, reported that a separate insurer, Unitedhealth Group, was the subject of a survey by the Ministry of Justice concerning the potential violations of unpertified health insurance. Unitedhealth has rejected, Call the article “deeply irresponsible” And to say that he had not been informed by the Doj as for such an investigation.
Whatever the way this attention is shaking up, Medicare Advantage, the alternative from the private sector to home insurance, should continue to examine control because it covers more than half of the people registered. But the plans, which often Include not covered advantages by the traditional government program, Cost more expensive than taxpayers by registration and aroused criticism to oblige patients to obtain prior authorization For some services, something rarely required in original health insurance.
The DOJ trial alleges that insurers have made significant payments that they have described as “marketing” or “sponsorship” costs to bypass the rules that establish ceilings on broker commissions. Payments, according to the trial, added incentives – often more than $ 200 per registration – so that brokers allow the health insurance beneficiaries to their coverage “regardless of the quality or adequacy of insurers' plans”.
The case joins the DoJ in a previously filed denunciation trial brought by an employee of then Ehealth, Andrew Shea. The lawyer for the denunciator, Gregg Shapiro, said that his client was grateful that the DOJ has chosen to intervene: “People with Medicare must know that when an insurance agent recommends a plan, this recommendation is based solely on customer needs and preferences of the customer,” said Shapiro in a statement sent by e-mail.
Although the Trump administration has filed the case under investigations initiated by the Biden administration, politics experts claim that Congress and insurers must do more.
“What we see in this trial highlights the terrible incentives that desperately need the congress to reform,” said Brian Connell, vice-president of Leukemia & Lymphoma Society, a defense group.
