The DOJ has brought seven causes of actions under the False Claims Act, which imposes liability on individuals or entities that knowingly submit false claims to the government or engage in related fraudulent conduct.

In a 217-page complaint filed on May 1, 2025, the U.S. Department of Justice (DOJ) brought civil claims under the False Claims Act against major health insurers—Aetna, Elevance Health (previously known as Anthem) and Humana—alleging they paid hundreds of millions of dollars in kickbacks to some of the country’s largest insurance brokers to steer Medicare beneficiaries into their Medicare Advantage plans. Medicare Advantage—a $450 billion program through which private insurers deliver federal health benefits to seniors and people with disabilities—is a critical revenue driver for the nation’s largest health insurers.

According to the DOJ, the insurers disguised these kickbacks as marketing payments to brokers—including eHealth, GoHealth and SelectQuote—who then prioritized higher-paying plans over more suitable or higher-quality options. The complaint also alleges that Aetna and Humana pressured brokers to reduce enrollment of disabled beneficiaries, a cohort perceived as costlier and less profitable to cover, in violation of federal anti-discrimination laws.

The allegations originated with a whistleblower complaint filed in November 2021 by Andrew Shea, former senior vice president of marketing at eHealth. The DOJ has since intervened and filed suit on behalf of the United States.

The DOJ alleges that, while publicly claiming to be “unbiased,” “carrier-agnostic” and to “have [citizens’] best interests in mind,” the brokers steered Medicare beneficiaries to insurer plans paying the brokers the most lucrative incentives, regardless of plan quality. The financial arrangements between the insurers and brokers were concealed from regulators through misleading labels such as “marketing,” “co-op” or “sponsorship” fees.

The DOJ uncovered a series of incriminating internal communications that, according to the government, demonstrate the “[d]efendants knew what they were doing was illegal.” For example:

• When discussing a purported “marketing” agreement with Humana, one eHealth executive joked that Humana was paying eHealth “$15 [million]/year for a [web]site that drives 15 enrollments per year,” adding sarcastically, “[Centers for Medicare & Medicaid Services] will surely never figure that one out. … Luckily the govt [sic] are generally morons.”
• Commenting on Aetna’s agreements, another eHealth executive acknowledged, the “marketing” payment model was “not even a little compliant. … I’m pretty sure if Aetna got audited by [Centers for Medicare & Medicaid Services], they’d be [in trouble].”

The complaint further alleges that Aetna and Humana used kickbacks to pressure brokers into enrolling fewer Medicare beneficiaries with disabilities, whom the insurers perceived as being more costly to cover. In doing so, Aetna and Humana allegedly violated federal laws prohibiting discrimination based on disability and mandating equal treatment of all eligible enrollees. As a result of the kickbacks, brokers allegedly rejected referrals, screened calls and steered disabled individuals away from Aetna and Humana plans.

The DOJ has brought seven causes of actions under the False Claims Act, which imposes liability on individuals or entities that knowingly submit false claims to the government or engage in related fraudulent conduct. See 31 U.S.C. § 3729(a)(1). According to the complaint, “Insurers received money from Medicare based on the presentation of false claims tainted by kickbacks or rendered false by illegal discrimination against persons with disabilities.”

Even though the Trump administration appears to have reined back investigation and enforcement of Foreign Corrupt Practices Act allegations, it seems to remain keenly focused on the False Claim Act—particularly in the healthcare sector, as this case illustrates. Indeed, during his Senate confirmation hearing in March, Mehmet Oz, President Trump’s administrator of the Centers for Medicare & Medicaid Services, pledged to prioritize cracking down on fraud in Medicare Advantage. Oz noted that such fraud and abuse could divert resources from providers caring for patients with more serious conditions.

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