Any lawyers here to provide input on this, or anyone aware of the laws related to this?
7 replies (most recent on top)
They probably don't care because they're not going to be any AIP. A reduction in employee benefits probably means no bonuses for 2025. So nurses are working their butts off and will get nothing in return and therefore no kickbacks given. It's a huge WIN for Humana.
@e3 - I fully agree with everything you said and feel the same!
@c7 - thank you and yep this is illegal and unethical like many of us have thought! I appreciate your thoughtful response!
In healthcare, percentage-based performance ratings linked to sales or referrals that lead to bonuses can be problematic under the Anti-Kickback Statute (AKS).
The issue is that they are basically telling the nurses if you do not meet 25% sells than you do not meet you metrics, thus you do not get as much if a bonus or a raise as those that do. This seems lto many of us like a kickback for the nurses that have a higher percentage in mail order pharmacy sells. The nurses that exceed Humana's expectations/matrics/ratings/performance get more money, how is this not a kickback, and how is this not ethically wrong. Nurses should be worried abouth heath, not their sells numbers/percentages, not worried about how their company is going to rate their yearly performance on selling their product. How is it the nurses fault if someone says NO! This is the part that is crossing a thin line og becoming illegal and ethical wrong. They have sells agents for this and I can't wait for someone to crab this story and run with it. Let me repeat again, Each and every nurse has a quota Humana is forcing them to meet, Post discharge medication reconciliation is part of the nursing performance at 42%, Mail Order Pharmacy is 25%, In Home Wellness Assessments are part of the nurses yearly evaluation and raises and bonuses are assessed on how well we sell all of the products this year. Happy selling all. I can see maybe post discharge medication, but not forcing mail order over and over and over and over, even after they have said no 10 times already
- Legal considerations
In most U.S. states, there’s no law outright banning a nurse from discussing their employer’s products or services, provided it’s not deceptive, coercive, or violating telemarketing/solicitation laws.
If the conversation is tied to insurance enrollment, Medicare, or Medicaid, there are strict CMS marketing guidelines—especially for Medicare Advantage and Part D—that prohibit unsolicited marketing during non-sales calls unless the member has given prior permission.
Nurses must avoid misrepresenting the service as “required” for care or implying it’s the only option available if that’s not true—otherwise, it could cross into false advertising territory. That is why this year they added the disclaimer that it's one of their options
- Ethical considerations
ANA Code of Ethics and nursing practice standards put patient advocacy and autonomy first. If your conversation with a member is primarily for care coordination, pivoting into sales—especially if it feels pressured—can create a conflict of interest and erode trust.
Ethically, you should only present pharmacy services if they are clinically relevant, or in the patient’s best interest.
Many nurses feel this blurs the professional boundary between healthcare and marketing.
It isn't illegal in any way. Employers can require whatever they want (legally) of the employees in this respect. The members can decline.