Act III · CH-01 — Financial Context: Follow the Money

Chapter 01 Table of Contents

The Financial Context

Before examining the forty-one document-based questions that follow the preliminary disclosure questions below, the financial context in which UC’s retiree coverage transfer program operates must be understood. The following eight documented facts — drawn from published research, federal litigation, and UC’s own published benefit rates — establish the financial incentive structure underlying the program that transferred Harold from UC High Option Medigap coverage to Via Benefits.

Fact 1 — Employer Adoption of Medicare Advantage Has Doubled

Source: Kaiser Family Foundation (KFF), Medicare Advantage in the Employer Market (2024). The percentage of large employers offering Medicare Advantage to retirees doubled from 26% to 56% between 2017 and 2023. Fifty-six percent of employers offering Medicare Advantage report lower costs compared to traditional Medicare supplement plans.

Fact 2 — Billions in Documented Savings to Employers

Source: Fortune Well (June 11, 2024). New York City projected $600 million in annual savings by switching 250,000 retirees to Medicare Advantage. Connecticut projected $400 million. NYC retirees sued and won an injunction blocking the mandatory transfer. The court found the transfer violated retirees’ contractual rights.

Fact 3 — Forced Transfers and Loss of Benefits

Source: USC Schaeffer Center for Health Policy & Economics, Medicare Advantage is Covering More and More Americans; see also The Conversation (2025); The Conversation (2024). Researchers documented that employers are forcing retirees into Medicare Advantage through group waiver plans, and retirees who refuse lose all employer-sponsored health benefits entirely.

Fact 4 — Medicare Advantage Costs Taxpayers More, Not Less

Source: Medicare Payment Advisory Commission (MedPAC) / Kiplinger. Medicare Advantage plans cost the federal government 123% of what traditional Medicare costs for equivalent beneficiaries. Cumulative overpayments to Medicare Advantage insurers exceed $520 billion. The savings accrue to the employer; the costs shift to taxpayers and beneficiaries.

Fact 5 — UC’s Own Numbers: $727.48/Month vs. $8,000/Year Maximum

Source: UCnet Retiree Health Benefits. Harold’s UC High Option Supplement to Medicare premium is $727.48 per month ($8,729.76 annually for retiree and spouse). UC’s maximum annual HRA contribution under Via Benefits is $8,000 for retiree plus spouse. The difference represents UC’s per-retiree cost savings on each transfer.

Fact 6 — The One-Way Street: Medigap to Medicare Advantage

Source: USC Schaeffer Center / The Conversation (2024); see also The Conversation (2025). Once a retiree is transferred from Medigap to Medicare Advantage, returning to Medigap is nearly impossible in most states. Arizona is among the thirteen states that do not require Medigap insurers to accept applicants outside the initial enrollment period. A retiree transferred to Medicare Advantage in Arizona who later finds the coverage inadequate may be permanently locked out of Medigap coverage.

Fact 7 — Elevance Health (Anthem’s Parent): $230 Million in Alleged Kickbacks

ACTIVE FEDERAL LITIGATION — YOUR INSURER IS A NAMED DEFENDANT

Source: United States Department of Justice, United States ex rel. Shea v. eHealth, Inc., et al., Case No. 21-cv-11777 (D. Mass.). The DOJ’s False Claims Act complaint alleges that Elevance Health, Inc. — the parent company of Anthem Blue Cross, Harold’s insurer — paid broker GoHealth more than $230 million in kickbacks from 2017 to 2021 to steer Medicare beneficiaries into Medicare Advantage plans. The complaint alleges violations of the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) and the False Claims Act (31 U.S.C. §§ 3729–3733). The complaint specifically alleges discrimination against disabled Medicare beneficiaries, who were rejected as referrals and strategically directed away from plans because they were considered costlier to insure. A federal judge denied Elevance Health’s motion to dismiss on March 25, 2026, and the case is proceeding to trial.

Fact 8 — Willis Towers Watson: The “Two Horse Race”

DOJ IDENTIFIES UC’S TRANSFER PLATFORM CONTRACTOR AS CO-DOMINANT IN THE MARKET

Source: United States Department of Justice, United States v. Aon plc, Case No. 1:21-cv-01633 (D.D.C.). The DOJ described the retiree exchange market as a “two horse race” dominated by Willis Towers Watson (Via Benefits’ parent company) and Aon. Willis Towers Watson is not a neutral marketplace — it is a dominant market actor whose business model depends on the volume of retirees transferred from employer group plans to the Via Benefits platform. UC contracted with this entity to administer the transfer of its retirees.

Key Finding: Harold is a documented disabled retiree (Octagon Risk Services, August 8, 2001, never revoked) whose insurer (Elevance Health/Anthem) is a named defendant in active federal Anti-Kickback Statute litigation, and whose employer (UC) contracted with a firm the DOJ has identified as co-dominant in the retiree exchange market (Willis Towers Watson/Via Benefits) to administer the transfer program. The financial incentive structure underlying this transfer — at every level — favors the transfer and disfavors the retiree.

Documents referenced herein that were created by UC, issued by UC, filed by UC, retained by UC, or filed with the IRS under penalty of perjury, or generated by UC’s own contracted insurer, are UC’s own institutional record. Documents created by the undersigned were created in direct response to UC’s own records and communications. Where UC’s own institutional records are not produced to clarify this audit, the author will rely on California Evidence Code § 413, under which the failure to produce evidence within a party’s control permits the inference that such evidence would be adverse to the party withholding it.

Submitted for Regulatory Review and Public Accountability

Charles A. Harold Jr.
UCLA Police Department (Retired?), Badge #341
Founder and First President, Federated University Police Officers’ Association (FUPOA)

I affirm that the information contained in this document and its exhibits is true and accurate to the best of my knowledge and good faith belief, submitted under the protections of 31 U.S.C. § 3730(h) (False Claims Act anti-retaliation) and California Labor Code § 1102.5.