American prosecutors accuse vast insurers of paying jet for private Medicare plans

On Thursday, the Department of Justice accused the three largest health insurers in the country of paying hundreds of millions of dollars in illegal jet in a few years to insurance brokers who directed people to private Medicare plans.

Federal prosecutors also accused two insurers of collision with brokers to discriminate against disabled people, by discouraging to sign up for private Medicare plans, because insurers believed that protection would be more high-priced.

About 12 percent of Medicare beneficiaries are less than 65 years senior, covered by a federal insurance program because they are disabled. Their care may be high-priced, taking into account the convoluted health needs.

According to complaintOriginally brought by the exposure and attached to the Department of Justice, the three largest health insurance companies in the country; Elevance Health, previously known as the hymn; And Humana – they are accused of paying jet with three vast brokers, Ehealth, Gohealth and SelectQue to raise the number of entries to your Medicare Advantage plans. These brokerage companies are also responsible for improper behavior.

. complaintComposed in the Federal Court in Boston, he stated that the rejection took place from at least 2016 to 2021 and accused Aetna and Humana of discrimination of the disabled.

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

The lawsuit is one of the first signs of Trump’s administration that some Medicare Advantage plans will continue to be subject to federal control. Critics of these plans, including Congress legislators, dropped the extremely popular policy of applying too aggressive marketing tactics and reloading of the federal government. Medicare Advantage plans now include more than half of all people enrolled in the federal program.

During the interrogation in the Senate for Dr. Mehmet Oz, currently the administrator of Medicare and Medicaid centers, he told senators concerned about the surplus of private plans that there was a “recent sheriff” in the city.

Brokers often play a key role in helping older and disabled Americans qualifying for Medicare to decide which private plan to choose. In the complaint, brokers are accused of introducing a person to the plan that paid him best, and not best suited to the needs of that person.

In recent years, diminutive local brokerage houses have given way to vast domestic organizations employing many agents and using telephone centers and websites, such as companies listed in the lawsuit. Now they rely on computer programs to lend a hand brokers identify the best plan for every caller, technology that can facilitate control in the lawsuit.

Last year, the biden administration finalized regulation Designed to reduce fees, insurers could pay these companies for saving patients Congress testimonies and consumer complaints that insurers awarded bonuses for registration of more people in individual plans, regardless of their individual needs. But the lawsuit stopped the principle.

Referring to matters related to the disabled, the federal prosecutors were blunt: “alleged efforts to distract beneficiaries in particular because their disability can make them less profitable for insurance companies, they are even more unsupported,” said US prosecutor Leah B. Foley. “Profit and greed over the beneficiary’s interest are something that we will continue and aggressively prosecute.”