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Epoch Times
02-05-2025
- Business
- Epoch Times
US Files False-Claim Complaint Against Health Insurance Companies, Brokers
The Department of Justice filed a complaint under the False Claims Act on May 1 against three health insurance companies and three large insurance brokerage organizations, alleging that hundreds of millions of dollars in kickbacks were paid by the insurance companies to the brokers in exchange for enrollments into their Medicare Advantage plans. The insurer defendants are Aetna Inc., and its affiliates, Humana Inc., and Elevance Health Inc. (formerly known as Anthem). The broker defendants are eHealth Inc. and one of its affiliates, GoHealth Inc., and SelectQuote Inc. According to the complaint, the kickbacks were allegedly paid out from 2016 through at least 2021. DOJ explained in a press release that the Medicare Advantage Program beneficiaries may choose to enroll in plans offered by private insurance companies, and many of those beneficiaries rely on brokers to help them choose the best plan to meet their needs. 'Rather than acting as unbiased stewards, the defendant brokers allegedly directed Medicare beneficiaries to the plans offered by insurers that paid brokers the most in kickbacks, regardless of the suitability of the MA plans for the beneficiaries,' the DOJ stated in 'According to the complaint, the broker organizations incentivized their employees and agents to sell plans based on the insurers' kickbacks, set up teams of insurance agents who could sell only those plans, and at times refused to sell MA plans of insurers who did not pay sufficient kickbacks.' DOJ also alleged that Humana and Aetna conspired with the brokers to discriminate against beneficiaries with disabilities deemed to be less profitable by allegedly threatening to withhold the kickbacks to the brokers. Related Stories 4/17/2025 4/8/2025 'Health care companies that attempt to profit from kickbacks will be held accountable,' said Deputy Assistant Attorney General Michael Granston of the Justice Department's Civil Division. 'We are committed to rooting out illegal practices by Medicare Advantage insurers and insurance brokers that undermine the interests of federal health care programs and the patients they serve.' The lawsuit was originally filed under whistleblower provisions under the False Claims Act, which permits the United States to intervene and take over the action. 'The alleged efforts to drive beneficiaries away specifically because their disabilities might make them less profitable to health insurance companies are even more unconscionable,' said U.S. Attorney Leah B. Foley for the District of Massachusetts. 'Profit and greed over beneficiary interest is something we will continue to investigate and prosecute aggressively. This office will continue to take decisive action to protect the rights of Medicare beneficiaries and vulnerable Americans.' According to the
Axios
01-05-2025
- Business
- Axios
DOJ alleges Medicare Advantage plans paid illegal kickbacks
The Justice Department on Thursday sued three of the biggest Medicare Advantage insurers, charging they paid insurance brokers hundreds of millions of dollars in illegal kickbacks to steer seniors into their plans. Why it matters: The case in U.S. District Court for the District of Massachusetts signals that the Trump administration is open to scrutinizing the privately-run Medicare program that now covers more than half of U.S. seniors. "We are committed to rooting out illegal practices by Medicare Advantage insurers and insurance brokers that undermine the interests of federal health care programs and the patients they serve," Deputy Assistant Attorney General Michael Granston said in a release. Where it stands: The False Claims Act complaint states that Aetna, Elevance (formerly Anthem) and Humana entered into illegal agreements with Medicare brokerages eHealth, GoHealth and SelectQuote to get them to enroll more seniors in their respective plans. Both the insurers and the brokers knew these arrangements, which stretched from 2016 through at least 2021, were illegal, the complaint states. The brokers are also named as defendants. DOJ also alleges that Aetna and Humana leveraged illegal kickbacks to brokers to enroll fewer Medicare enrollees with disabilities, since they're often more expensive to cover. Medicare Advantage plans are typically required to accept any eligible senior in their service area who wishes to enroll, regardless of pre-existing conditions. What they're saying: "We are still reviewing the complaint, but disagree with the allegations and intend to defend the case vigorously," Phillip Blando, executive director of external affairs for Aetna and CVS Caremark, told Axios. Humana also said in a statement that it strongly disagrees with the allegations and will defend itself in the legal proceedings. GoHealth told Axios it was disappointed in the government's decision to intervene several years after an initial whistleblower complaint was filed. "We intend to vigorously defend against these allegations, and we will not allow this litigation to distract from our mission to provide peace of mind to the Medicare beneficiaries that we serve," the company said in a statement.
Yahoo
22-04-2025
- Business
- Yahoo
Walgreens to pay up to $350M for filling illegal opioid prescriptions, Justice Department says
Walgreens has agreed to pay up to $350 million as part of a settlement with the U.S. Justice Department to resolve claims that the company illegally filled millions of invalid prescriptions for opioids and other controlled substances and asked for payment for many of those invalid prescriptions by Medicare and other federal healthcare programs. The DOJ said a $300 million settlement is based on Walgreens' ability to pay and an additional $50 million will be owed if the company is sold, merged or transferred before fiscal year 2032. "Pharmacies have a legal responsibility to prescribe controlled substances in a safe and professional manner, not dispense dangerous drugs just for profit," Attorney General Pamela Bondi said in a statement. "This Department of Justice is committed to ending the opioid crisis and holding bad actors accountable for their failure to protect patients from addiction." Walgreens Sued By Doj, Alleging It Knowingly Filled Illegal Prescriptions Including 'Dangerous' Opioids The company was accused of filling millions of invalid prescriptions between August 2012 and March 2023 in violation of the Controlled Substances Act, according to the government's complaint. These included prescriptions for excessive numbers of opioids and opioid prescriptions filled significantly early. Walgreens pharmacists allegedly filled these prescriptions despite signs suggesting a high likelihood that the prescriptions were invalid because they lacked a legitimate medical purpose or were not issued in the usual course of professional practice, the DOJ said. Read On The Fox Business App Walgreens To Go Private In $10B Deal The complaint also claims that Walgreens pressured its pharmacists to fill prescriptions quickly and without taking time to confirm that each prescription was legal. Walgreens' compliance officials also allegedly ignored evidence that its stores were dispensing illegal prescriptions and even intentionally deprived its own pharmacists of necessary information, including by refusing to share internal data about prescribers with pharmacists and preventing pharmacists from warning one another about certain prescribers. The federal government said the lawsuit and resulting settlement were part of efforts to address the national opioid epidemic that has led to tens of thousands of deaths each year. "This settlement resolves allegations that, for years, Walgreens failed to meet its obligations when dispensing dangerous opioids and other drugs," Deputy Assistant Attorney General Michael Granston of the Justice Department's Civil Division said. "We will continue to hold accountable those entities and individuals whose actions contributed to the opioid crisis, whether through illegal prescribing, marketing, dispensing or distributing activities."Original article source: Walgreens to pay up to $350M for filling illegal opioid prescriptions, Justice Department says
Yahoo
22-04-2025
- Business
- Yahoo
Walgreens will pay up to $350M for filling illegal opioid prescriptions, DOJ says
The Brief Walgreens agreed to pay up to $350M as part of a settlement with the federal government for filling millions of illegal opioid prescriptions. The company also tried to illegally get federal reimbursement for the prescriptions through various federal health care programs, the DOJ said. The settlement between Walgreens and the Justice Department was announced on Monday. WASHINGTON, D.C. - Walgreens has agreed to pay up to $350 million as part of a settlement with the federal government over allegations that the national pharmacy chain illegally filled millions of invalid opioid prescriptions. The company was founded in Chicago and is headquartered in suburban Deerfield. The settlement between Walgreens and the Justice Department was announced on Monday. What we know Walgreens was accused of filling millions of illegal prescriptions between 2012 and 2023 in violation of the Controlled Substances Act. The company also tried to receive federal reimbursement for the prescriptions through various federal health care programs in violation of the False Claims Act, according to the nationwide lawsuit filed in the U.S. District Court for the Northern District of Illinois. The DOJ said the settlement amount is based on Walgreens' ability to pay and $50 million of the total is based on whether the company is sold, merged or transferred prior to 2032. What they're saying Federal officials said the lawsuit and settlement was part of combating the nationwide opioid epidemic, which has resulted in the deaths of tens of thousands of people each year. "Pharmacies have a legal responsibility to prescribe controlled substances in a safe and professional manner, not dispense dangerous drugs just for profit," said Attorney General Pamela Bondi. "This Department of Justice is committed to ending the opioid crisis and holding bad actors accountable for their failure to protect patients from addiction." "This settlement resolves allegations that, for years, Walgreens failed to meet its obligations when dispensing dangerous opioids and other drugs," said Deputy Assistant Attorney General Michael Granston of the Justice Department's Civil Division. "We will continue to hold accountable those entities and individuals whose actions contributed to the opioid crisis, whether through illegal prescribing, marketing, dispensing or distributing activities."
