HHS says it has launched a study into “misleading” Medicare Advantage marketing practices “and the harms they cause to individuals.”
“In recent years, concerns about aggressive and deceptive marketing practices in Medicare Advantage have become more pressing,” the HHS OIG wrote in July. “These concerns have focused on agents and brokers used by Medicare Advantage plans who target and mislead seniors, at times enrolling them in plans without their knowledge or directing them to plans that substantially increase their out-of-pocket costs.”
The study will focus on complaints received by CMS from 2020 to 2024, specifically looking at the actions taken by agents and brokers that led to the complaints and the incentive structures that encouraged brokers to change individuals’ enrollments. The final study is expected to be released in 2026.
In 2023, CMS finalized a rule aimed at addressing issues related to misleading MA marketing by prohibiting ads that lack specific plan details or mislead beneficiaries through imagery and language.
In December 2024, the HHS OIG issued an alert about the potential for fraud and abuse related to MA marketing schemes. Specifically, the OIG raised concerns over financial arrangements between MA plans, healthcare professionals and brokers that could incentivize steering beneficiaries toward plans that are not necessarily the best fit, violating anti-kickback laws.
In May, the Department of Justice filed a lawsuit against Humana, Aetna, and Elevance, along with brokers eHealth, GoHealth, and SelectQuote, accusing them of engaging in a multi-year scheme to pay millions of dollars in kickbacks to steer beneficiaries toward specific plans, regardless of quality or suitability. The DOJ alleges that brokers were incentivized to prioritize plans with the highest payments, resulting in the submission of thousands of false claims and discriminatory practices against disabled beneficiaries.
In March, a Senate report showed a major increase in insurer spending on brokers and third-party marketing organizations, increasing from $2.4 billion in 2018 to $6.9 billion in 2023.
