Tag Archives: paying

US Prosecutors Charge Major Insurance Firms with Paying Kickbacks for Private Medicare Plans

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The Justice Department has charged three major health insurance companies with engaging in illegal kickback schemes totaling hundreds of millions of dollars over several years, involving payments to insurance brokers who guided individuals to private Medicare plans.

Federal prosecutors also alleged that two of these insurers colluded with brokers to discriminate against individuals with disabilities by hindering their enrollment in private Medicare plans, based on the belief that these plans would be costlier.

Around 12% of Medicare beneficiaries, who are disabled and under the age of 65, qualify for the federal insurance program. Their intricate health requirements often lead to high care costs.

According to a complaint initially filed by whistleblowers, the Department of Justice has joined the case against the nation’s largest health insurance company, previously known as Anthem. Humana is also implicated for allegedly funneling kickbacks to three large brokers—Ehealth, GoHealth, and SelectQuote—to boost enrollment in Medicare Advantage plans, which have also been tied to fraudulent activities.

A complaint filed in federal court in Boston claims that the kickback scheme spanned from at least 2016 to 2021, accusing Aetna and Humana of discrimination against individuals with disabilities.

Aetna, Elevance, GoHealth, and Humana have denied the allegations, although others have not responded to requests for comments.

This lawsuit is one of the first indications of the Trump administration’s scrutiny of certain Medicare Advantage plans, which face ongoing federal oversight. Critics, including lawmakers, have condemned these popular plans for potential overcharging the federal government through aggressive marketing strategies. Over half of all individuals enrolled in the federal program are covered by Medicare Advantage plans.

During the Senate confirmation hearing for Dr. Mehmet Oz, he assured concerned senators about the oversight of Medicare plans, promising a “new sheriff” to address excesses.

Brokers play a crucial role in assisting senior Americans in selecting private Medicare plans. However, the allegations suggest brokers have directed individuals to plans that offer the highest commissions instead of the best fit for their needs.

In recent years, small local brokerage firms have been overshadowed by large national organizations that employ numerous agents and utilize call centers and websites like those mentioned in the lawsuit. These companies increasingly depend on technology to help brokers identify the optimal plans for callers, facilitating the kind of steering described in the allegations.

The Biden administration implemented regulations last year aimed at reducing the commissions insurance companies can pay to brokers for patient enrollments. Recent Congressional testimonies and consumer complaints have indicated that insurers are offering bonuses to brokers for enrolling more individuals in specific plans, regardless of their actual needs. However, the lawsuit is still pending.

Regarding cases involving disabled individuals, federal prosecutors have stated: “The efforts to specifically exclude beneficiaries are even more ruthless given that their disabilities may render them less profitable for health insurance companies,” said attorney Leah B. Foy. “We will continue to investigate and prosecute the greed targeting these beneficiaries.”

Source: www.nytimes.com

Apple settles lawsuit by paying $95 million over claims Siri listened to private conversations

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Apple has agreed to pay $95 million in cash to settle a class action lawsuit alleging that its voice assistant, Siri, violated users’ privacy and listened to them without their consent.

iPhone owners complained that Apple routinely recorded private conversations after users unintentionally activated Siri and made those conversations available to third parties, including advertisers. The preliminary settlement was filed Tuesday night in federal court in Oakland, California, and must be approved by U.S. District Judge Jeffrey White.

Voice assistants typically respond when you use a “hotword” such as “Hey, Siri.” The two plaintiffs said references to Air Jordan sneakers and Olive Garden restaurants prompted advertisements for those products. One person said he received an advertisement for a well-known surgical treatment after a personal discussion with his doctor. The plaintiffs argued that Apple did not receive consent before recording their conversations and, in fact, could not have obtained consent because one of the plaintiffs was a minor and did not have an Apple account at the time of the recording.

The complaint alleges that the violations continued from September 17, 2014 to December 31, 2024. The violation allegedly began with the addition of a “Hey, Siri” function to Siri, which led to unauthorized recordings. Estimated tens of millions of class participants can receive up to $20 per Siri-enabled device, such as an iPhone or Apple Watch.

Apple denied any wrongdoing in the settlement agreement. The company has consistently emphasized the importance of privacy. In 2018, Apple CEO Tim Cook criticized other technology companies for their surveillance, saying: ‘[t]His desire to prioritize profit over privacy is nothing new.” The company further countered in a letter to Congress. 2018 Apple’s iPhone devices do not “listen” to you, other than detecting the audio trigger “Hey Siri.”

But in a 2019 Guardian report cited in the original complaint, an Apple whistleblower revealed that contractors regularly listen to users’ private conversations when performing quality assurance on Siri. He said that he had done so. These conversations included confidential medical information, drug deals, and recordings of couples having sex. Some of these conversations were recorded by mistake, the whistleblower said, because Siri can mistake things like the “zip sound” as a wake word.

At the time, Apple said that only a “small percentage” of Siri requests are evaluated for quality, and those requests are not tied to a user’s Apple ID. “Siri responses are analyzed in a secure facility, and all reviewers are obligated to comply with Apple’s requests.” Strict confidentiality requirements. “The company then paused A quality improvement program has been installed to stop audio recording by default.

The Cupertino, Calif.-based company and its lawyers did not immediately respond to requests for comment Thursday. Lawyers for the plaintiffs did not immediately respond to a similar request. They could seek $1.1 million in fees and costs, up to $28.5 million in a settlement fund.

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For Apple, whose net income was $93.74 billion in its most recent fiscal year, $95 million is equivalent to about nine hours of profit.

A similar lawsuit on behalf of users of Google’s voice assistant is pending in federal court in San Jose, California, which is in the same district as the Oakland court. The plaintiffs are represented by the same law firm that worked on the Apple case.

Source: www.theguardian.com