The recent article against carriers is about admin overrides and marketing money. Read this article

[DonP]

I found it. This is the complaint that also mentions WellCare, brokers' favorite carrier. And there are other numbers and quotes in this one.

https://litigationtracker.law.georgetown.edu/wp-content/uploads/2025/05/US-ex-rel-Shea_2025.04.29_AMENDED-COMPLAINT.pdf

Seems that Georgetown's law school tracker has lots of cases available for the public to read.

Great find . Incredible detailed on the inner workings of what's going on . I read the whole 88 pages and it shows the mass corruption and steering using massive overrides and marketing money to sways app's . Huge changes coming in payments structures no question.Some of my takes in this just by memory

1. WellCare was giving $500 an app admin fee to ehealth ( this combined overrides and marketing money to). What's fascinating they were also giving $125 bonus in month 13 and month 25 In addition to the $10-$12 a month in renewal overrides . This is eye popping . Justice dept mentioned the renewal override bonus payments steered ehealth to leave the plan in force causing them not to shop for better plans .
2. In 2020 ehealth made $67 million in marketing money alone . Thats was 64% of their profit
3. Justice dept said " These marketing payments took away benefits from Medicare beneficiaries "


. This has peeled the onion layers back and now we know were the $1000-$1300 total per app Comes from . Overrides (admin fees )are included in all this because each fmo negotiates there own deals ( One might get $175 and another gets $250-$300 an app admin fee) . This also causes steering . All this comes down to sweetheart deals and different carriers making different deals with fmo's to drive vol . This investigation started in 2021 and i believe it was the basis for the 2024 cms lawsuit to ax admin and marketing money . What these lawsuits are saying is the govt wants all carriers to be on the same playing field with set commissions and no volume based overrides to steer Medicare beneficiaries

 

[Special Agent]

Great find . Incredible detailed on the inner workings of what's going on . I read the whole 88 pages and it shows the mass corruption and steering using massive overrides and marketing money to sways app's . Huge changes coming in payments structures no question.Some of my takes in this just by memory

1. WellCare was giving $500 an app admin fee to ehealth ( this combined overrides and marketing money to). What's fascinating they were also giving $125 bonus in month 13 and month 25 In addition to the $10-$12 a month in renewal overrides . This is eye popping . Justice dept mentioned the renewal override bonus payments steered ehealth to leave the plan in force causing them not to shop for better plans .
2. In 2020 ehealth made $67 million in marketing money alone . Thats was 64% of their profit
3. Justice dept said " These marketing payments took away benefits from Medicare beneficiaries "


. This has peeled the onion layers back and now we know were the $1000-$1300 total per app Comes from . Overrides (admin fees )are included in all this because each fmo negotiates there own deals ( One might get $175 and another gets $250-$300 an app admin fee) . This also causes steering . All this comes down to sweetheart deals and different carriers making different deals with fmo's to drive vol . This investigation started in 2021 and i believe it was the basis for the 2024 cms lawsuit to ax admin and marketing money . What these lawsuits are saying is the govt wants all carriers to be on the same playing field with set commissions and no volume based overrides to steer Medicare beneficiaries

how many less people would have used a supposedly unbias call center platform to enroll if they had fully understood that they were not going to get unbias advice? some of those enrollments would have been done by street agents so we were damaged by these call centers too but no one cares about that.

 

[MedicareWAA]

surprised no one on Medicare monsters posted it . All these lawsuits tie together . Carriers have used bribery taxpayer money to steer business as the profit has been so high . I'll give up all marketing money if it puts the call centers and fmo mass telesales shops out of business .

Not sure how to post something in that group. Maybe they had trouble finding it, too.

 

[DonP]

Not sure how to post something in that group. Maybe they had trouble finding it, too.

The reason there's nothing on there about this is the 1st day of the lawsuit Justin Brock warned against smearing the go healths and carriers . He was no doubt warned by the higher ups to keep all this off social media . This is very bad for fmo's and carriers . If the cms ruling had gone through the lawsuit might have progressed like it is but the problem of the last 20 yrs would have already been addressed . Give the fmo only $100-$150 an app to do contracting and some training . No more overrides below the $100-$150 and no renewal overrides . The agent gets the extra $100 an app and he can get his own Sunfire or Connecture .

 

[Special Agent]

The reason there's nothing on there about this is the 1st day of the lawsuit Justin Brock warned against smearing the go healths and carriers . He was no doubt warned by the higher ups to keep all this off social media . This is very bad for fmo's and carriers . If the cms ruling had gone through the lawsuit might have progressed like it is but the problem of the last 20 yrs would have already been addressed . Give the fmo only $100-$150 an app to do contracting and some training . No more overrides below the $100-$150 and no renewal overrides . The agent gets the extra $100 an app and he can get his own Sunfire or Connecture .

I read his spiel about not jumping to conclusions on this issue but give me a break. I never used Sunfire or Connecture so i don't know how it compares but Health Sherpa Medicare is free and they have been adding features like provider search. Hopefully the goldrush for these call centers and big FMOs is over.

 

[DonP]

My note above proves why you can't say crap on Facebook groups . I posted anomonously about a sensitive subject and the admin of the group got angry . If you threaten these dirty cooks bread and butter they go wild . There day is coming .

 

[MedicareWAA]

I really don't think overrides are at risk except if carriers need to save money. The stuff we are reading about isn't about overrides. It's other cash. But if a carrier has to cut admin spending, I think they'll be a lot more comfortable cutting overrides vs commissions.

It would be nice if overrides were truly standardized. I'm not convinced someone's administrative burden is that much greater, per policy, when they sell 1,000 policies vs 10,000 policies. If anything, the more you write, the more efficient you should be on a per app basis.

While we're at it, just make EVERYTHING standardized and make everyone pay the standardized amount. No more cherry picking commissionable plans. No more "max" fmv. No more varying comp by plan and by carrier. If a carrier wants to sell any of its products using a broker, make the carrier pay a standard amount on every single plan offered by the carrier. Or you can just go DTC and struggle.

If fmv is the fair value, make everyone pay the fair value. Paying less is unfair. Paying more is unfair.

 

[DonP]

The puzzle is coming together . Cms last yr just didn't pop up and say " we're taking away admin overrides and marketing money " out of the blue . This lawsuit was filed in 2021 and I believe this was the blueprint for the mandate for cms last yr . These lawsuits you linked talk an awful lot about the different " admin overrides" and how they're all different . Here's the bottom line . Most people who've been getting overrides ( I've gotten some ) will say this has nothing to do with overrides. Of course nobody wants their cash cow to go away . IMHO the only way to have a fair level playing field is to have standardized agent commissions and no overrides or marketing money . Fmo's could get reimbursed some fair amount for what they do . I still reiterate all this money is paid basically taxpayer funded and trump and congress want to cut costs ti the bone . None of us know what will happen . But I suspect at the very least if this not settled by aep carriers will still pull back hard .#1 because profit margins under big pressure and #2 this lawsuit shook them up . Let's be honest . The last 10 yrs there's been a gold rush mania by call centers and Fmo's to scale huge because of the 10's if millions of profit in Medicare . What business in the world can you basically build for Almost no to little cost that can be sold for $10-$75 mil ? The marketing money and overrides covered Al ost all the cost . So the loa pay to the cms commission was profit . Ad in the millions in the renewal overrides and the actual $26.08 you kep from what the loa wrote . This business has had some of the highest profit margins on the planet