People v. Doherty et al., No. 04800-2005 (NY Sup. Ct. , Apr. 28, 2008)
A New York County grand jury indicted eight employees of the insurance broker Marsh McLennan, alleging that they colluded with certain insurers to arrange noncompetitive excess casualty bids and conveyed the bids to clients under false pretenses. Two of the former employees were convicted on a single count each of violating the Donnelly Act, New York’s antitrust statute, and were sentenced to 16 weekends in jail and five years probation. The court dismissed twenty other larceny and fraud counts. At least eighteen other people have pleaded guilty to charges stemming from New York’s investigation of the insurance industry. The remainng defendants were acquitted of all charges. In 2010, the trial judge threw out the convictions on the basis of newly-discovered evidence.
Connecticut v. Marsh & McLennan Companies et al., , No. X05-CV-05-4004360-S (Ct. Super. Ct. 2009)
Plaintiff state originially sued insurance carrier ACE, alleging kickbacks from ACE to Marsh. See In the Matter of ACE Ltd. and ACE Group Holdings, Inc. The state later expanded the lawsuit against Marsh, alleging that, when Marsh customers wanted to purchase insurance or renew insurance they already had, Marsh brokers frequently decided which insurer should be given the business and at what price. Marsh’s quote for insurance was typically a substantial increase — as much as 15 to 20 percent — over the previous year’s price.
United States et al. v. Aetna et. al., No. 1:16-cv-01494 (D.D.C. July 21, 2016)
U.S. DOJ and plaintiff states sued to block the merger of two of the country’s largest health insurers. According to the complaint, alleges that their merger would substantially reduce Medicare Advantage competition in more than 350 counties in 21 states, affecting more than 1.5 million Medicare Advantage customers in those counties. Before seeking to acquire Humana, Aetna had pursued aggressive expansion in Medicare Advantage. Aetna, the nation’s fourth-largest Medicare Advantage insurer by membership, has nearly doubled its Medicare Advantage footprint over the past four years. Humana is the nation’s second-largest Medicare Advantage insurer by membership. The lawsuit also alleges that Aetna’s purchase of Humana would substantially reduce competition to sell commercial health insurance to individuals and families on the public exchanges in 17 counties in Florida, Georgia and Missouri, affecting more than 700,000 people in those counties. The lawsuit alleges that by buying Humana, Aetna would eliminate one of its strongest and most capable competitors in these markets. The district court granted the injunction, rejecting the parties arguments that the Medicare Advantage and Medicare programs were competing products that constrained one another’s prices, and noting that Aetna’s exit from several markets, allegedly because of the Affordable Care Act, appeared to be designed to eliminate a problem with the merger, rather than being an unrelated business decision.
United States et al. v. Anthem et al., No. 1:16-cv-01493 (D.D.C., July 21, 2016)
The US and plaintiff states sued to block the merger of two of the country’s largest health insurers. The complaint alleges that their merger would substantially reduce competition for millions of consumers who receive commercial health insurance coverage from national employers throughout the United States; from large-group employers in at least 35 metropolitan areas, including New York, Los Angeles, San Francisco, Denver and Indianapolis; and from public exchanges created by the Affordable Care Act in St. Louis and Denver. The complaint also alleges that the elimination of Cigna threatens competition among commercial insurers for the purchase of healthcare services from hospitals, physicians and other healthcare providers. According to the complaint, the merger would eliminate substantial head-to-head competition in all these markets, and it would remove the independent competitive force of Cigna, which has been a leader in the industry’s transition to value-based care. the court granted the injunction. Anthem appealed to the DC Circuit, which affirmed the district court.
State of West Virginia ex rel., Darrell v. McGraw, Jr., Attorney General v. Acordia of West Virginia, Inc., No. 04-C-115 (Cir. Ct. Hancock Cty. WV)
In 2004, the State filed suit,claiming that certain insurance practices related to the placement of insurance policies violated the State of West Virginia’s Antitrust and Consumer Credit and Protection Acts. The Attorney General sought damages under the Antitrust Act on behalf of the State, its public agencies, counties, municipalities, and other political subdivisions, and as parens patriae of natural person who are citizens and residents of the State. Case was settled for $8 million to be distributed by WV AG’s office.
Hawaii v. American International Group (AIG) Inc., No. 08-1-0191-01 (Haw. Cir. Ct. 1st. Dist. Jan. 29, 2008)
State court proceedings to implement settlement reached with AIG, resolving alleged bid-rigging and false insurance quotes, as well as payment of secret “contingent commissions” to brokers. See also NY v. AIG, Ohio v. AIG, Hawaii v. ACE Holdings.
Hawaii v. ACE Holdings, Inc., No. 07-1-2015-10 (Cir. Ct. 1st Cir. Hawaii, Oct. 25, 2007)
Consent decrees filed by states in state court required $4.5 million payment and conduct relief to remedy alleged bid-rigging and false insurance quotes, as well as payment of secret “contingent commissions” to brokers.
U.S. and Michigan v. Blue Cross Blue Shield of Michigan, 10-14155 (E.D.Mich. 2013)
USDOJ and plaintiff state challenged the use by Blue Cross/BlueShield of Michigan of Most Favored Nation clauses, alleging that their power in the market, combined with these clauses, violated state and federal antitrust law by stifling competition, leading to higher costs, and preventing new entry into the market. After the state legislature enacted a statute prohibiting health insurers from using most-favored-nation clauses in contracts with health care providers, USDOJ and Michigan dismissed the case.
IN the matter of the Chubb Corporation, Mass. Super. Ct. (Sullfolk)
State reached settlement with The Chubb Corporation (“Chubb”) resolving allegations that Chubb’s compensation practices offered improper incentives and enabled Boston-based insurance brokerage firm William Gallagher Associates Insurance Brokers, Inc. (“WGA”) to direct business to Chubb. As part of the settlement, Chubb will pay $182,815 to WGA customers and $56,196 to the Commonwealth to be used in insurance mediation.
Massachusetts v.William Gallagher & Associates
State filed a complaint and a Consent Judgment against Boston-based insurance broker William Gallagher Associates Insurance Brokers, Inc. (“WGA”) for billing customers for unauthorized and undisclosed compensation and misleading customers about the brokerage firm’s contingent commission practices and involvement in reinsurance. Contingent commissions, also known as profit sharing commissions, are controversial incentive-based compensation programs offered to brokers by insurance companies. WGA agreed to return $3,017,003 to eleven clients, pay at least $925,000 in sanctions and attorneys fees to the State, and submit to a binding audit of its Energy and Environmental practice group. The Judgment also requires WGA to send statements to over seven hundred customers to correct prior allegedly false representations the company made regarding its employees’ knowledge of contingent commissions and WGA’s participation in reinsurance. Reinsurance is a form of insurance that insurance companies purchase to protect themselves against their policyholders’ claims. Going forward, WGA has agreed to provide enhanced compensation disclosures to customers by providing written notice of all fees and commissions.