Medicare Advantage Kickbacks and Broker Steering: When Enrollment Payments Are Relabeled as Marketing

The Medicare Advantage kickbacks lawsuit alleges that insurers paid brokers to steer enrollments into their plans while describing the payments as marketing or administrative services. For someone in sales operations, contracting or finance, the revealing document may be the reconciliation: the invoice counts leads, but the payment depends on issued policies. You may know why those two counts differ.

The Department of Justice joined a case brought by a former eHealth employee in May 2025. It alleged that Aetna, Humana and Elevance Health, formerly Anthem, paid eHealth, GoHealth and SelectQuote hundreds of millions of dollars in kickbacks to favor their plans from 2016 through at least 2021.

This branch of Medicare Advantage fraud reaches the people who negotiate distribution agreements, approve invoices and run enrollment teams. A contract can describe a website. The spreadsheet beside it can count how many policies the broker promised to sell.

The Business Behind the Broker’s Invoice

Insurers pay agents and brokers for enrollment work. Broker compensation includes initial and renewal payments, while separate arrangements can cover marketing and administrative services. The Centers for Medicare & Medicaid Services describes the wider distribution business as third-party marketing organizations, which perform lead generation, marketing, sales and enrollment functions.

The government’s complaint describes the reason for relabeling the payments: CMS capped enrollment commissions, while insurers could pay separately for administrative services at their market value. The government alleges that insurers used those service labels to pay brokers extra for policy sales.

A lead identifies a potential customer. A call or live transfer connects that person with someone who can discuss coverage. An issued policy records the enrollment the insurer gained. In the government’s complaint, those different events matter because the parties allegedly described payment for one while calculating it from another.

The American Institutes for Research’s 2026 report, Medicare Advantage Fraud, Waste, and Abuse Policy Options, describes commissions alongside administrative payments for work such as training, certification and technology support. Its concern is how the incentives affect the options a beneficiary hears about.

When Marketing Payments Followed Policy Sales

The government’s complaint alleges that enrollment commitments controlled payments described as website support, leads and calls. The clearest examples connect the contract to a second document: an internal spreadsheet, an invoice revision, a payment approval or a reconciliation.

Humana’s Mini-Site and the Unwritten Sales Commitment

The complaint alleges that Humana described payments to eHealth as funding to maintain a mini-site and direct traffic to it. The website largely functioned as a landing page, while the payments allegedly bought commitments to sell specified numbers of Humana policies and give Humana preferential treatment.

The complaint describes eHealth employees explaining that the contract named the mini-site, while production commitments remained on spreadsheets and in telephone conversations.

The complaint recounts Humana discussing a contract amendment for a website its own account manager could not locate or describe.

Aetna’s Policies Became Leads on Paper

While reviewing a slide presentation, an Aetna employee proposed a way to express a policy payment as a lead payment. The complaint quotes the employee proposing an invoice for 100 policies at $200 each as an invoice for 1000 leads at $20 each instead.

The complaint then quotes an Aetna executive explaining that the agreements needed to describe lead generation while the company could count applications internally. The choice of words was deliberate, according to the government. Inside the business, the measure remained how many policies the broker sold.

SelectQuote’s dealings with Humana supply an alleged invoice change involving actual commitments. The complaint says SelectQuote replaced 13,000 policies with 110,000 leads on an invoice even though the services had not changed. A presentation still stated the policy commitment. The paperwork changed its unit of measurement while the promised work stayed the same.

A Payment Approval Still Counted Issued Sales

The Aetna and SelectQuote allegations also show why the approval email can be more revealing than the invoice. In April 2020, SelectQuote submitted an invoice describing March marketing. Internally, the request for approval identified 1,954 issued sales at $215 per sale, totaling $420,110.

According to the complaint, an Aetna executive refused to approve an invoice for sales, calling that noncompliant. Aetna ultimately paid it.

The Reconciliation Revealed What Earned the Money

The complaint says Aetna’s agreement with GoHealth made a marketing fee depend on new policies remaining in effect for at least 90 days. The government points out that GoHealth would incur lead and marketing expenses whether or not a beneficiary stayed enrolled that long.

A GoHealth employee identified the issue while reviewing the agreement, according to the complaint: a one-time lead-generation fund was probably acceptable, but once the agreement reconciled the payment against policies not written, it became Aetna paying for issued policies.

The reconciliation connected payment to the result the insurer wanted. For a finance insider, that connection shows up in the reconciliation adjustments after an enrollment period, even when the original funding request describes only marketing expenses.

The Anthem and GoHealth allegations make the same distinction in calls. The complaint says Anthem paid a $7 million invoice describing 140,000 live transfers. The signed agreement omitted the production target the parties had agreed upon. In a later message about another payment, an Anthem executive told internal accounting that, with the agreements no longer called marketing agreements, the invoices would say calls delivered while the underlying agreement was still for sales.

Accounting received the explanation the invoice left out.

How the Payment Changed the Plans a Caller Heard

The government alleges that brokers delivered favored enrollments through dedicated sales teams, plan suppression and agent incentives. Those are different points in the sales process: who answers the call, which plans appear on the screen and what the agent earns for recommending one.

According to the complaint, SelectQuote maintained a team that sold only Humana plans without clearly informing beneficiaries of that limitation. The government also describes SelectQuote developing a quoting-tool feature that could suppress competing plans by state. The allegation reaches the menu the agent could offer, as well as the recommendation the agent made.

GoHealth allegedly proposed sending callers from advertisements that did not carry Anthem’s brand to agents who sold only Anthem products. Its agent incentives also rewarded prioritizing Anthem. The complaint quotes one offer of a $25 gift card for an agent spotted opening a call with Anthem. The insurer’s preference had reached the first part of the sales conversation.

The same report explains why the compensation structure matters beyond any single allegation:

The report also identifies opacity in lead generation as a risk: information about a potential enrollee can pass to marketing businesses before the person understands who is contacting them. Together, lead sourcing, call routing and compensation can shape the sales conversation before the caller hears a recommendation.

The complaint gives a concrete account of the harm. It describes a beneficiary receiving cancer treatment who switched from Original Medicare and TRICARE to a Humana plan after speaking with an eHealth agent. The beneficiary’s healthcare providers were outside the new plan’s network, leaving the beneficiary facing $17,000 in costs, according to the complaint. A plan sale can count as a success inside the broker’s business while disrupting the buyer’s health care.

The government separately alleged that Aetna and Humana used payment pressure to steer disabled beneficiaries away from enrollment. The complaint describes call filters that routed disabled beneficiaries away from agents selling Aetna plans and an eHealth change that left Aetna plans visible but disabled the enrollment button.

Why the Enrollment Count Matters to Medicare

Medicare pays an Advantage insurer monthly for each enrolled beneficiary. The plan’s payment per member reflects risk adjustment. The broker’s enrollment work therefore connects a sales transaction to a continuing stream of government payments.

The government alleges that the insurers sought Medicare payments for enrollments bought through kickbacks while falsely promising to follow the rules against those payments. Its complaint describes insurers submitting beneficiary enrollment information to CMS to receive payment. That connects the broker arrangements to the False Claims Act case.

The money does not stop at the broker’s invoice. The enrollment file connects the person recruited through the arrangement to the insurer’s claim for Medicare money. Taxpayers funded the enrollments, beneficiaries heard a narrowed choice, and competing plans lost their place on the sales screen.

Referral Payments Can Follow Different Routes

The payer, recipient and event earning the money change across referral cases. The national broker complaint concerns insurers paying broker organizations for favored plan sales. Other resolutions concern a healthcare provider paying insurance agents, or a plan paying staff in medical offices.

Oak Street Paid for Referrals to Its Business

Oak Street Health agreed to a $60 million settlement in September 2024 over allegations that it typically paid insurance agents $200 per beneficiary referred or recommended. The Department of Justice described agents contacting seniors eligible for or enrolled in Medicare Advantage and delivering messages intended to generate interest in Oak Street.

Interested people then reached an Oak Street employee through a three-way telephone call, known as a warm transfer, or an electronic submission.

Here, the provider allegedly paid the agent to bring someone to the provider’s business.

Gift Cards Reached Medical-Office Staff

MCS Advantage agreed to a $4.2 million settlement in July 2022 over allegations involving gift cards to providers’ administrative assistants. The government said the cards induced referrals, recommendations or arrangements for new Medicare enrollments.

MMM Holdings later settled similar gift-card allegations for $15,228,340 in December 2024. Those allegations likewise concerned administrative assistants referring or arranging beneficiary enrollments.

The recipient here worked in a provider’s office. A referral incentive could reach someone a patient encountered before speaking with an insurance sales agent.

The Records Behind the Service Description

A contracting employee may know why an enrollment target disappeared from a draft. A finance employee may know which count determined the payment. A sales-operations employee may know how the favored plan reached a dedicated team or gained priority in the quoting tool. Those accounts connect the promise, the calculation and the conduct on the sales floor.

We work with insiders to connect those decisions to the enrollment and payment records. An internal explanation of the actual deal can be the most revealing document in the file.

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

If you know why a marketing invoice was calculated from policy sales, speak with our whistleblower experts about the agreement behind it. We work with you to build your strongest Medicare Advantage kickbacks case around the payment, the enrollment and the decisions connecting them. We bring in Medicare Advantage whistleblower lawyers who understand broker-payment arrangements, and we stay beside you through the whole journey.