SelectQuote: Humana-Only Calls and Aetna Sales Incentives

The SelectQuote Medicare Advantage kickbacks lawsuit alleges that Humana and Aetna bought favored enrollments through payments dressed as marketing money, while SelectQuote restricted the plans its agents sold and rewarded the sales those insurers wanted. The government’s complaint follows the money into the call center: a Humana-only team, a tool that could hide competing plans, and an Aetna payment arrangement that changed which carrier the agents had reason to favor.

The Justice Department joined the qui tam case on May 1, 2025, filing its complaint in Massachusetts against insurers Aetna, Humana and Elevance Health, formerly Anthem, and brokers SelectQuote, eHealth and GoHealth. Its broker-steering allegations cover conduct from 2016 through at least 2021. SelectQuote’s part of the story is unusually concrete. Employees who handled calls, carrier contracts, commissions or invoices would recognize the decisions the complaint describes.

What the Marketing Payments Bought

The government alleges that the insurers paid SelectQuote for additional enrollments and favorable treatment on its sales platform, beyond ordinary commissions. Medicare pays private insurers monthly for each enrolled beneficiary. The government alleges that SelectQuote caused insurers to submit false claims by steering enrollments in return for kickbacks, which is why it sued the broker under the False Claims Act. On that account, taxpayers funded enrollments the insurers bought, and competing carriers lost access to customers when they would not pay.

The sales channel has several jobs before an enrollment happens. Third-party marketing organizations can generate leads, advertise plans, employ agents and handle enrollment. The Centers for Medicare & Medicaid Services describes ordinary agent and broker compensation as an initial payment followed by smaller renewal payments when the beneficiary stays in the plan.

The American Institutes for Research explains why the commission and administrative payment need to be read together. Its 2026 report, Medicare Advantage Fraud, Waste, and Abuse Policy Options, identifies payment differences as an incentive affecting which plans agents present. The report explains that CMS caps enrollment commissions but leaves administrative payments for non-enrollment work uncapped, allowing insurers to sidestep the commission limits.

The complaint contrasts SelectQuote’s public promise of unbiased plan comparisons with its private sales arrangements. It alleges that contracts described marketing campaigns and leads while internal discussions counted sales, allocated calls and decided which competing insurers would remain available.

Humana-Only Calls Behind the Tiburon Name

SelectQuote established Tiburon Insurance Services in July 2016 to operate a team of agents selling Humana plans, according to the government’s complaint. The complaint says SelectQuote executives chose the carriers and approved the agents’ compensation, while the insurer contracts remained with SelectQuote.

For years, the government alleges, Tiburon sold only Humana plans without clearly telling beneficiaries about that limitation. The complaint quotes SelectQuote’s then senior vice president explaining how the agents identified themselves:

The alleged restriction survived the call’s opening. The complaint says SelectQuote trained agents to “think eat sleep and be Humana” and to transfer callers to its multi-carrier agents only as a last resort. Selling a Humana plan paid the agent much more than making that transfer. According to the complaint, SelectQuote also disciplined Tiburon agents who transferred too many beneficiaries to its multi-carrier Choice agents.

An agent raised the conflict internally in January 2017. The complaint quotes the agent objecting that a sale should serve the beneficiary’s interest and describing colleagues who felt penalized for transferring callers instead of selling Humana. The objection came from someone doing the selling, who could see when the available plan was wrong for the caller.

The alleged restriction also reached SelectQuote’s broader platform. In an April 2017 proposal seeking Humana funding, SelectQuote said it would temporarily remove Aetna. The complaint later quotes a Humana manager explaining that SelectQuote had restored Aetna only in markets where Humana lacked a strong presence, after asking Humana where its plans would not compete.

That allegedly gave the insurer influence over both sides of a sale: which agent received the caller and which competing plan the agent could offer. A beneficiary could ask for a comparison without reaching someone allowed to make it.

Aetna’s Payment Tiers Changed the Preferred Carrier

Aetna’s alleged arrangement shows how the same sales operation could change its allegiance when the money changed. SelectQuote added Aetna to Tiburon around August 2018, the complaint says, but continued paying Tiburon agents twice as much to sell Humana until August 2019. SelectQuote then offered Aetna a preferred position in exchange for more marketing money.

For the arrangement confirmed in fall 2019, the complaint states that Aetna agreed to pay SelectQuote $215 per sale, rising to $360 as sales volume grew. Those were payments to the brokerage. SelectQuote separately changed what its agents could earn.

According to the complaint, Tiburon agents were offered full commissions for Aetna sales while Humana sales paid half commissions. An additional Aetna bonus began at $5 per sale and rose to $20 per sale for agents making fifty or more Aetna sales.

The complaint says SelectQuote planned to route volume toward Aetna during the annual enrollment period while giving Humana low priority and no routed volume. It alleges that Aetna’s share of SelectQuote sales rose after the compensation changes. Later, when Aetna reduced its payments, SelectQuote lowered Aetna’s priority and cut the agent commission for its plans.

The complaint also describes a later instruction to maximize Aetna sales after SelectQuote exceeded Humana’s paid enrollment ceiling. An executive explained that additional Humana sales diluted the economics of its capped marketing payment, while Aetna continued paying for more sales. On the government’s account, the next enrollment was worth more from one carrier than the other.

The Quote Engine Could Remove the Competition

SelectQuote’s Quote Engine could suppress carriers by state, according to an internal message quoted in the complaint. An operations analyst described the feature in November 2017 as allowing SelectQuote to turn plans off whenever it wanted. That made carrier availability a management setting on the agent’s screen.

The AIR report identifies this same industry problem. Software supplied through third-party marketing organizations can limit the plan options agents see, and the report recommends prohibiting suppression technology. A restricted screen narrows the comparison before an agent recommends anything. In the SelectQuote allegations, the carrier negotiations and the software settings belong in the same account of how a sale happened.

When Policies Became Leads on the Invoice

SelectQuote’s proposed invoice wording changed what Aetna appeared to be buying while keeping the payment tied to policy sales, the government alleges. In May 2019, a SelectQuote executive proposed a pay-for-performance arrangement, adjusting invoices upward or downward depending on whether the brokerage exceeded or missed its enrollment commitment.

The complaint gives the executive’s example: describe 100 policies at $250 each as 1000 leads at $25 each. He explained why the wording mattered:

The complaint also describes an actual invoice and the approval discussion behind it. SelectQuote sent Aetna a $420,110 invoice labeled “2020 March Marketing (FY2020).” An Aetna manager asked whether it represented leads. Another employee explained internally that the amount represented 1,954 sales above an agreed threshold.

When the approval request described issued sales, an Aetna executive said he would not approve an invoice for sales because that was noncompliant. The government alleges that Aetna nevertheless paid it.

In the government’s account, the description changed more readily than the business arrangement. For someone in contracting or finance, the revealing connection is between the service named on the invoice and the sales count used to approve it.

The Benefits the Sales Incentives Passed Over

SelectQuote’s own managers raised concerns about whether the favored plans suited their customers, according to the complaint. A Tiburon sales manager observed that most clients had Medicaid or low incomes and that Humana and UnitedHealthcare offered better benefits for them. The manager specifically identified dental, vision, transportation, over-the-counter and meal benefits, and said Aetna’s reimbursement approach required money that low-income clients could not afford to advance.

The complaint describes another SelectQuote program, Wellcare Direct, in which a team concentrated on Wellcare plans. It cites complaints that were 33% higher in one period than under SelectQuote’s general sales model. A sales operations director explained that Choice agents sold Wellcare when it was the best fit, while Wellcare Direct sold it even when another carrier’s plan better met the client’s needs. The complaint quotes an executive’s response to that explanation: “We don’t want to say this.”

The USC-Brookings Schaeffer Initiative for Health Policy explains the stakes in its 2017 paper, Medicare Advantage: Better Information Tools, Better Beneficiary Choices, Better Competition. It reports that keeping a familiar doctor or hospital can matter more than a lower price, while complex choices and inadequate information can overwhelm beneficiaries. Suppressing a competing plan can remove the very option that would preserve an existing care relationship.

The government also alleges steering beneficiaries with disabilities away from enrollment. Aetna and Humana allegedly threatened to withhold payments to pressure the brokers to enroll fewer disabled beneficiaries, whom the insurers viewed as less profitable.

Where the Payment Meets the Sale

The SelectQuote allegations connect decisions across departments. A carrier agreement sets the commercial terms. A routing instruction sends callers to a particular team. The quote engine controls the available plans, and the compensation schedule rewards the agent for the carrier the company wants sold. The invoice and its approval discussion show what the insurer ultimately paid for.

Each employee sees a different part of that sequence. Sales staff know which plans disappeared and what managers said about transfers. Operations staff know who changed the routing or carrier settings. Finance staff know whether the calculation behind a marketing invoice counted leads or issued policies. Compliance staff see the complaints and internal objections alongside the sales decisions that generated them.

For a whistleblower, the strength is in those connections. An agent’s objection about benefits gains meaning beside the carrier’s payment terms and the bonus schedule. An invoice becomes more revealing when the approval email measures a different service. We work with insiders to build the case around those decisions and the people inside the business who understood them.

A Related Kickback Case Bought Patient Referrals

Oak Street Health’s September 2024 settlement shows another way money can follow an insurance agent’s recommendation. The company agreed to pay $60 million over allegations that it paid agents to refer Medicare Advantage beneficiaries to its healthcare business.

Agents contacted eligible or enrolled seniors and passed interested people to Oak Street through a three-way call or an electronic submission. The alleged payment was typically $200 per beneficiary referred or recommended. Oak Street allegedly bought a patient referral to a provider. The SelectQuote allegations concern insurers buying favored plan enrollments.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Why That Plan Was Sold

If you handled the calls, changed the carrier settings or approved invoices priced by enrollment, talk with our whistleblower experts about what drove those sales. We build the payment and steering case with you, bring in Medicare Advantage kickback whistleblower lawyers, and stay beside you through the pursuit of a recovery.