Elevance and Anthem: Marketing on the Invoice, Sales in the Deal

The Elevance and Anthem Medicare Advantage broker kickbacks lawsuit alleges that the insurer bought enrollments through payments described as marketing services. The government’s complaint follows the money into invoices, sales commitments and rewards for agents who pushed Anthem plans. For someone who approved those contracts or worked on the sales floor, the question is familiar: what did the broker actually have to deliver to get paid?

Elevance Health, formerly Anthem, is the insurer named in the Justice Department’s May 1, 2025 complaint announcement. An eHealth executive brought the qui tam case, and the government joined it in Massachusetts. The wider complaint names insurers Aetna, Humana and Elevance, and brokers eHealth, GoHealth and SelectQuote, alleging conduct from 2016 through at least 2021.

This branch of Medicare Advantage fraud concerns how beneficiaries reached a plan. The government’s account turns on what Anthem paid brokers to sell and what those brokers told people choosing health coverage.

What Anthem Paid Its Brokers

The government’s complaint focuses its Anthem payment allegations on GoHealth and eHealth. It alleges that Anthem paid GoHealth more than $230 million from 2017 through at least 2021 in exchange for commitments to meet specific enrollment targets. It separately alleges that Anthem paid eHealth over $46 million in marketing money from 2017 through 2021.

According to the complaint, the paperwork changed while the deal still required sales. The employee processing a bill for marketing services could be paying for an enrollment commitment.

The Invoice Said Calls, the Deal Said Sales

Anthem’s alleged payment arrangements treated calls as the invoice description and sales as the underlying obligation. The complaint describes an agreement whose final written version omitted the production target the parties had agreed upon. GoHealth then submitted a $7 million invoice in January 2019 for 140,000 live transfers at an average internal cost of $50 each. Anthem paid it that month.

Elsewhere, the complaint quotes an Anthem executive objecting to a new definition of a call. The executive could accept the definition, but did not want it to create a debate over what counted as a call because the underlying business agreement was sales. The concern was whether the wording might loosen the sales obligation.

The complaint also quotes a Director of Sales telling the accounting department how a GoHealth payment would be presented:

The insurer’s own sales staff told accounting to pay for sales under the name of calls, according to the complaint. Under that alleged arrangement, beneficiaries were steered toward the paying insurer, and Medicare paid for the enrollments.

The same divide reached the audit process. According to the complaint, GoHealth asked Anthem in April 2021 for a note to its auditors saying that the broker earned its compensation once minimum call-volume thresholds were met. GoHealth supplied proposed language describing payment for calls delivered. The government alleges that this misrepresented the underlying enrollment agreement.

Someone who knows how an invoice was approved may know which measure actually controlled payment: calls delivered or plans sold.

How Anthem Preference Reached the Agent

The complaint describes carrier payments turning into broker staffing decisions and agent rewards. In March 2020, GoHealth proposed routing calls from advertisements without Anthem branding to a dedicated team whose agents would sell only Anthem products. A caller responding to a general advertisement could therefore reach a sales operation built around one insurer.

The incentive could also be immediate. The complaint quotes this offer to agents:

That reward attached to which plan the agent pitched first. It put the carrier preference at the opening of the conversation, before the caller had heard the alternatives.

The complaint also describes what happened when the incentive changed. In April 2020, a GoHealth executive attributed falling Anthem sales in Chicago to a new compensation plan that paid evenly across carriers.

What the Complaint Says Anthem Knew

According to the complaint, an Anthem executive valued the sales growth from brokers that created the impression of shopping across the market and choosing the best plan while steering people toward Anthem in exchange for marketing investments.

The appearance of comparison was part of the alleged attraction. A beneficiary could believe the broker had considered the market, while the insurer paying for preference gained the sale.

The complaint also describes warnings about the result. In May 2019, an Anthem employee alerted colleagues to a spike in complaints from GoHealth customers who said they had never requested enrollment in an Anthem plan. The government alleges that Anthem continued paying GoHealth to encourage additional sales despite those complaints.

Those enrollment-without-consent complaints give the payment dispute a human consequence. People were telling the insurer that they had not wanted the coverage its broker had sold them. For an insider in complaints, sales oversight or finance, the important connection is between what the company heard and the payments it approved afterward.

The broader lawsuit also accuses Aetna and Humana of steering disabled beneficiaries away from enrollment.

Broker Compensation Reaches Beyond the Commission

Medicare Advantage broker compensation includes initial enrollment payments and renewal payments. The Centers for Medicare & Medicaid Services explains the usual payment structure: an agent or broker receives an initial payment, then generally half as much in later years if the member remains enrolled. CMS caps per-enrollment commissions. The complaint alleges that insurers disguised additional enrollment payments as marketing, co-op or sponsorship payments.

The American Institutes for Research’s 2026 report, Medicare Advantage Fraud, Waste, and Abuse Policy Options, explains why the whole payment arrangement matters. Broker employees may have different incentives from agents who contract directly with insurers, including incentives for new enrollments without renewal payments. The report identifies a consequence that bears directly on the alleged Anthem sales preference: compensation, administrative payments included, may influence which plans agents and brokers present and what they say about them.

That analysis helps explain why an agent’s commission schedule is only part of the picture. The complaint follows the carrier’s marketing budget into the broker’s operation, then into the choice of which plans an agent offered. Contracts, payment approvals and sales incentives describe different parts of the same alleged bargain.

A related payment pattern appeared in Oak Street Health’s 2024 referral-kickback settlement. The government alleged that the provider typically paid insurance agents $200 for each beneficiary referred or recommended, including through a three-way phone call. In that arrangement, the provider paid to bring people into its care. In the Anthem allegations, the insurer paid brokers to bring people into its plans.

The Records Behind the Sales Commitment

The Anthem allegations connect agreements and invoices to sales instructions, agent incentives and complaints. A finance employee may know why a bill described as calls required a discussion about sales. A broker manager may know how a carrier commitment became an agent’s target. An enrollment or compliance employee may know when customers began saying they had not asked to switch.

The government connects the alleged steering to claims for Medicare money. Its complaint identifies an Anthem enrollment obtained through eHealth and the Medicare payments that followed, then alleges that insurers falsely represented compliance with kickback rules in their enrollment submissions and payment attestations. The broker’s sales commitment sits at the beginning of that payment trail.

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

You Know What the Broker Was Paid to Deliver

If you know why an Anthem broker invoice said calls while the deal required sales, talk with our whistleblower experts. We build the case with you and bring in Medicare Advantage whistleblower lawyers who understand broker kickbacks, enrollment incentives and the payment trail. We stay beside you as that inside knowledge becomes a case for recovering public money.