DOJ lawsuit alleges illegal kickbacks and discrimination against vulnerable populations
The U.S. government has filed a major lawsuit against several of the country’s largest health insurance companies and brokers, alleging they prioritized profits over patient care. The case, United States ex rel. Shea v. eHealth, et al., (Case No. 21-cv-11777-DJC), was filed in the U.S. District Court for the District of Massachusetts.
What’s at Issue?
The Department of Justice (DOJ) alleges that from 2016 to 2021, companies including Aetna, Humana, and Elevance (formerly Anthem), along with brokers eHealth, GoHealth, and SelectQuote, engaged in illegal kickback schemes to drive Medicare Advantage enrollments.
Instead of helping individuals—many of whom were elderly or living with disabilities—choose plans based on their healthcare needs, brokers allegedly steered them toward plans that offered the highest commissions. According to the government, these companies:
- Prioritized plans that paid the largest financial incentives
- Limited broker teams to selling only high-commission plans
- Removed lower-paying plans from their offerings entirely
Most troubling, the DOJ alleges that some insurers actively avoided enrolling people with disabilities, viewing them as less profitable due to potentially higher healthcare costs.
How the Case Came to Light
The lawsuit was initiated under the False Claims Act by a whistleblower—an individual empowered by law to report fraud against government programs. Whistleblowers may receive a portion of any recovery resulting from the lawsuit.
In announcing the case, Deputy Assistant Attorney General Michael Granston emphasized that companies engaging in illegal kickbacks will be held accountable. U.S. Attorney Leah Foley underscored the injustice of targeting individuals with disabilities and steering them away from appropriate care.
The investigation is being led by the DOJ in coordination with the FBI and Department of Health and Human Services (HHS).
Why This Matters
This case sends a strong message: federal authorities are closely monitoring the healthcare marketplace and will act decisively against practices that harm patients and violate public trust. When companies put financial gain ahead of legal and ethical responsibilities, especially in programs like Medicare Advantage, the consequences can be significant—not only for the companies involved but for the patients they serve.
Authored by Lionel André, Founding Partner at SECIL Law PLLC. Lionel can be reached at landre@secillaw.com.
