eHealth, GoHealth and SelectQuote: When the Payment Chose the Plan

The eHealth, GoHealth and SelectQuote Medicare Advantage lawsuit alleges that Aetna, Elevance Health and Humana paid brokers hundreds of millions of dollars in kickbacks to steer people into their plans. The government’s complaint follows the alleged bargain from marketing agreements to agent incentives, call routing and the plans a caller could actually choose. If you worked on those agreements or sales systems, the familiar part may be the gap between what the invoice called the payment and what the insurer expected in return.

The Department of Justice filed its complaint on May 1, 2025, alleging kickbacks from 2016 through at least 2021. A former eHealth executive had brought the whistleblower case. The alleged conduct also reached whom the brokers discouraged from enrolling: Aetna and Humana allegedly used the payments to reduce enrollment by people with disabilities.

The Brokers Sold the Plans, the Insurers Paid Them

eHealth, GoHealth and SelectQuote sold Medicare Advantage plans online and by telephone. Aetna, Elevance Health and Humana operated the plans. Elevance was formerly Anthem, the name used throughout the complaint and the internal messages it quotes.

Medicare Advantage is the private-plan part of Medicare. Insurers contract with the Centers for Medicare & Medicaid Services and receive monthly payments for enrolled beneficiaries. Brokers sit between the insurer and the person choosing coverage. Their operations include generating leads, marketing, answering calls, comparing plans and submitting enrollment applications.

That division explains why this Medicare Advantage fraud case reaches both sides of the sale. The insurers allegedly supplied the extra money. The brokers allegedly used their sales operations to deliver the promised enrollments. Medicare then paid the insurers for the people enrolled in their plans.

What the Marketing Payment Allegedly Bought

The government alleges that the insurers bought preferential sales treatment with payments on top of ordinary commissions. Those extra payments carried names such as marketing, co-op, sponsorship and market development funds, often shortened to MDF in the companies’ messages.

The underlying broker compensation structure matters. CMS describes an initial payment when a beneficiary first enrolls and generally half as much in later years if the beneficiary stays. The complaint gives the national commission cap in 2021 as $539 per enrollment. It alleges that Anthem paid GoHealth more than $230 million in kickbacks from 2017 through at least 2021 in return for enrollment targets.

The complaint describes another calculation inside the companies: how many enrollments the broker would deliver for the additional money. In the eHealth-Humana arrangement, the written agreement described a Humana minisite on eHealth’s website. The complaint quotes eHealth’s director of carrier development explaining where the sales commitment lived: Humana was paying for the minisite and nothing more, while the production commitments were made by phone and on spreadsheets, never in the contract.

The spreadsheet gave the arrangement a sales target that the contract left out. Someone who saw only the contract would see a technology service. Someone who negotiated the production commitment would know what the payment was supposed to buy.

The Invoice Changed From Policies to Leads

The complaint alleges that companies changed the description on an invoice while keeping the enrollment bargain underneath it.

The complaint describes an internal Aetna discussion in which a national sales director proposed an invoice format that would replace 100 policies at $200 each with 1000 leads at $20 each. The complaint presents this as a proposed way to describe the same payment. Another Aetna executive responded that the agreements could describe lead generation while the company counted applications internally.

The SelectQuote-Humana example concerns an invoice the government says actually changed. SelectQuote allegedly replaced 13,000 policies with 110,000 leads, even though the services had not changed and the commitment remained policies. The complaint ties the revision to an exchange with Humana.

Anthem’s accounting staff received a similarly direct explanation about GoHealth. According to the complaint, an Anthem sales executive told them that the invoices would describe calls delivered, while the underlying agreement remained payment for sales. Across these arrangements, the useful comparison is the service in the contract, the unit on the invoice and the enrollment commitment kept elsewhere.

How the Brokers Allegedly Controlled the Choice

The alleged steering reached the sales tools and compensation plans, before an agent recommended anything. According to the complaint, callers typically supplied a birth date and zip code through a phone tree before reaching an agent. The brokers used that information to score calls, reject some and route others to particular agents.

At SelectQuote, the government says a team called Tiburon sold Humana plans exclusively. Its account of the training is unusually plain:

The complaint says SelectQuote paid those agents more to sell a Humana plan than to transfer a caller to an agent offering several insurers. It also describes discipline for too many transfers. An agent complained internally about the pressure to sell a Humana plan that did not fit the client.

At eHealth, executives allegedly responded to a Humana sales commitment by shutting off competing plans in selected states. The government says Humana sales increased after eHealth stopped selling UnitedHealthcare plans in those states. On that account, a caller seeking a comparison got a selection the broker had already narrowed.

At GoHealth, the complaint describes an Anthem override that gave calls a higher value in the routing system. It also describes instructions to pitch Anthem first. The preference reached both the software and the sales pitch.

The brokers advertised unbiased advice. The complaint describes SelectQuote training a team to think, eat and sleep Humana.

Aetna and Humana’s Disability-Selection Allegations

Aetna and Humana allegedly used the extra payments to discourage enrollment by Medicare beneficiaries with disabilities, whom they considered more expensive to cover. The complaint ties this risk selection to under-65 enrollment targets, quoting tools and call filters.

The Aetna-eHealth allegations show how a target could become a software setting. The government says eHealth discussed leaving Aetna plans visible in the agent’s quoting tool while disabling the enrollment button. The complaint alleges that eHealth later modified the tool to remove Aetna plans for certain callers based on age and state. The alleged restriction operated inside the broker’s system, where the beneficiary could not see which options had disappeared.

The Humana-GoHealth allegations include a verbal request to keep the under-65 share of business at no more than 20%. The complaint quotes a GoHealth executive connecting that target to the prospect of larger bonuses. The complaint says brokers also used dates of birth to reject or reroute calls and leads in response to Humana’s demands.

These allegations give the payment a further purpose: influencing both which insurer gained a member and which prospective members the broker turned away.

What the Plan Switch Meant for the Beneficiary

The complaint describes consequences that a sales total cannot show: lost access to existing providers and enrollment that callers said they never authorized.

In one example, an independent broker complained that an eHealth agent persuaded a beneficiary receiving cancer treatment to switch from Original Medicare and TRICARE to a Humana plan. The government says the beneficiary faced $17,000 in costs because the treating providers were outside the Humana network.

Another eHealth caller said she wanted information and intended to keep her UnitedHealthcare coverage, but later discovered enrollment in Humana without her permission.

The policy paper Medicare Advantage: Better Information Tools, Better Beneficiary Choices, Better Competition, published by the USC-Brookings Schaeffer Initiative for Health Policy in 2017, explains why the comparison itself matters. It described provider-network information that could be difficult to access, incomplete or outdated. Keeping an existing doctor or hospital could matter more to a beneficiary than a lower price. It also pointed to research showing that too many choices can overwhelm Medicare Advantage beneficiaries and lead them to poor enrollment decisions.

That finding explains the value of a broker’s help. In the alleged arrangements, the person relying on that help received a recommendation shaped by a payment they never saw.

How the Alleged Enrollments Reached Medicare

The government’s False Claims Act case connects the broker payments to the insurers’ requests for Medicare money. It alleges that the insurers submitted enrollment and payment data, certified its accuracy and promised compliance with rules against kickbacks. It also alleges false compliance claims by Aetna and Humana concerning disability discrimination.

The complaint supplies examples organized by insurer-broker pair, tying particular enrollments to claims and Medicare payments. For an insider, that joins the sales side of the business to the government payment side: the agreement, the enrollment it allegedly bought and the insurer’s submission for payment.

A related pattern appeared in Oak Street Health’s $60 million settlement announced in September 2024. The Department of Justice alleged that Oak Street paid insurance agents for referrals through telephone transfers or electronic submissions. There, the payment allegedly bought a patient referral to a provider. Here, the government alleges that insurer payments bought plan enrollments.

The Whistleblower Case and the Government’s Complaint

A former eHealth executive brought the qui tam case in 2021. The government later joined with its own complaint, carrying the kickback and disability-selection allegations described here.

The insider’s contribution is visible throughout the complaint: what the contract omitted, what the spreadsheet counted and what the sales team understood the money to mean. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

When You Know What the Payment Bought

Your work in broker funding, sales incentives or enrollment systems may tell you what the payment bought. Speak with our whistleblower experts about what happened inside the business. We turn your knowledge of the payments and sales decisions into a case strategy, bring in Medicare Advantage whistleblower lawyers who understand broker kickbacks, and stay beside you through the case.