Lawmakers and state officials are increasing pressure on federal regulators to stop unscrupulous, commission-hungry insurance agents from enrolling thousands of people in Affordable Care Act plans, or changing their coverage, without their knowledge.
Customers often do not discover the changes until they are denied medical coverage or no longer get medical coverage. stuck with the bill They must pay for the ACA tax credits.
Senate Finance Committee Chairman Ron Wyden (D-Ore.) said he would propose legislation to allow Centers for Medicare and Medicaid Services Holding fraudulent brokers “criminally responsible” for their actions. The agency that oversees the ACA exchanges can fine individuals up to a maximum of $1000. $250,000 Wyden said he had been accused of providing false information on an application for a health plan, but he did not admit to doing so.
“I am disappointed that these penalties have not yet been used to hold bad actors accountable,” Wyden wrote in an article last week. a strongly worded letter To CMS Chief Chiquita Brooks-LaSure,
Jimmy PatronisAs Florida’s chief financial officer overseeing agencies including insurance regulators, he called on Congress to pressure CMS to mandate two-factor authentication. Healthcare.gov and related platforms that agents use to sign people up for coverage. According to Patronis, the state has opened more than 900 checks Problem with enrollment.
“Preventing fraud in the first place is much easier than asking state regulators to crack down on these bad guys,” Patronis wrote.
The problem appears to be concentrated in the following people: 32 states By using the federal marketplace — Healthcare.gov — Because, brokers say, it’s very easy for rogue agents to access policyholder information. All they need is name, date of birth and state.
States that run their own insurance markets usually have additional protection requirements.
CMS matched 90,000 complaints About unauthorized sign-ups or plan switching in the first quarter of 2024 alone, out of more than 100 16 million Enrollment.
Jeff WuActing Director of Consumer Information and Insurance Inspection Center In CMS, his agency said is preparing regulatory and technical reforms, scrutinising brokers and working to get consumers back to their chosen plans.
But even with Wyden’s legislation introduced, Congress appears unlikely to take any action on it. Lawmakers are in the midst of an election year in which President Biden Trying to win votes To boost enrollment in ACA plans defeating his rival former president Donald Trumpfor his unsuccessful attempt to repeal the law.
Sabrina Corlett, Who follows ACA Market as co-director Center on Health Insurance Reform But Georgetown UniversityHe said the federal government could do more, including better coordinating with state investigations.
But he said states like Florida should also regulate markets.
“If there are so many bad brokers in Florida, then Florida needs to look within itself and put better controls on brokers,” he said.
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