Connect with us

Kaiser Health News

Oregon Senator Proposes Criminal Charges and Fines for Rogue Obamacare Agents

Published

on

Julie Appleby, KFF Health News
Wed, 24 Jul 2024 18:45:00 +0000

Health insurance agents who fraudulently enroll consumers in Affordable Care Act health plans could be subject to criminal charges — and civil penalties of $10,000 to $200,000 — under legislation introduced Wednesday by Sen. Ron Wyden (D-Ore.), chairman of the powerful Senate Finance Committee.

Wyden first promised the bill in May, when he called on federal regulators to do more to combat sketchy Obamacare enrollment schemes. Often, consumers who are targeted don’t know they’ve been enrolled or that their coverage has been switched to a new plan until they lose access to preferred doctors, learn they have different deductibles, or find they owe taxes for ACA insurance premium subsidies.

The schemes exploit the federal health insurance enrollment system, which requires only minimal proof of identity — a name, birth date, and state — for a broker to create or access an account. The lure is monthly commissions paid by insurance companies — amounts that are only about $25 per person but can add up when multiplied across transactions.

“It is critical for these bad actors to be held criminally responsible and implement common sense consumer protections so working families can confidently purchase quality, affordable health insurance that works for them through honest brokers,” Wyden said in a statement.

The Centers for Medicare & Medicaid Services said July 19 that more than 200,000 people have complained about unauthorized Obamacare enrollment or plan switches this year.

KFF Health News began reporting on Affordable Care Act enrollment schemes this spring.

CMS’ directive last week also detailed new rules aimed at thwarting the problem by blocking agents from making changes to consumers’ coverage unless they are already “associated” with that policyholder’s account, or take other steps to verify that they have consumers’ permission.

Wyden’s proposal, co-sponsored by Democratic Sens. Sherrod Brown of Ohio, Tammy Duckworth of Illinois, Patty Murray of Washington, Brian Schatz of Hawaii, and Chris Van Hollen of Maryland, would call on federal regulators to begin verifying that consumers have granted consent to brokers for ACA enrollment or plan switches, and to notify consumers whenever a change is made to their accounts or coverage.

The civil penalties would range from at least $10,000, in cases of straightforward negligence, to as much as $200,000 for agents who “knowingly and willfully” submit fraudulent information.

Wyden’s bill faces a seemingly impossible climb, landing in a very polarized Senate during an election year.

But next year, the ACA will be in the spotlight as Congress must decide whether to extend beyond 2025 enhanced subsidies that help people purchase coverage. Increased subsidies were instituted under the Biden administration at the height of the pandemic and are considered a key factor behind recent record ACA enrollment.

Some Republican lawmakers have demanded investigations of ACA enrollment-switching schemes, which they allege may be part of a larger problem of brokers or consumers misstating their incomes to garner insurance subsidies. Obamacare supporters say the complaint is a partisan effort to stop the enhanced subsidies from becoming permanent.

Sen. Chuck Grassley (R-Iowa) sent a letter July 8 to CMS questioning how federal regulators verify incomes for those who get subsidies and what enforcement efforts are underway related to potential ACA subsidy fraud.

Wyden’s office said his proposal is supported by some insurers and agent groups, including AHIP, the trade association for insurance companies; individual insurers like Centene Corp.; and several disease-specific patient advocacy groups, including the Leukemia & Lymphoma Society, the American Cancer Society Cancer Action Network, and the National Multiple Sclerosis Society.

Health Agents for America, a group that has sought solutions to the issue, supports criminal charges for agents found to be falsely enrolling or switching consumers but stopped short of endorsing Wyden’s bill. Ronnell Nolan, its president and CEO, said her organization would like to see more effort “to hold CMS responsible” for allowing what she views as security loopholes in private sector enrollment websites, and in enforcement actions against bad actors.

“The bottom line is to stop fraud and help the consumer,” she said.

In a July 19 letter to Wyden’s office, CMS Administrator Chiquita Brooks-LaSure outlined steps the agency has taken to increase “oversight of agents and brokers to protect consumers” — including suspending 200 agents in recent weeks from enrolling clients in Obamacare plans.

“The numbers being addressed are very low,” said Nolan, who suspects it isn’t just individual rogue agents seeking commissions by changing ACA enrollments, but a larger effort using automation to rapidly enroll or switch consumer policies.

Nolan and other agents say federal regulators should simply require private Obamacare enrollment sites to add layers of security before agents can access consumer accounts.

Eighteen states and the District of Columbia run their own ACA marketplaces and require additional security measures, including two-factor authentication, before consumer accounts can be accessed. Two-factor authentication, a common internet security feature, requires people to enter a code — usually sent to their phones — before accessing accounts at banks, social media platforms, and many other services.

The state-run enrollment sites report far fewer problems than the federal marketplace, Nolan and others say. If CMS simply added two-factor authentication to healthcare.gov, Nolan said, “all these other shenanigans would not happen.”

——————————
By: Julie Appleby, KFF Health News
Title: Oregon Senator Proposes Criminal Charges and Fines for Rogue Obamacare Agents
Sourced From: kffhealthnews.org/news/article/oregon-senator-proposes-criminal-charges-and-fines-for-rogue-obamacare-agents/
Published Date: Wed, 24 Jul 2024 18:45:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/world-famous-wall-drug-isnt-immune-from-challenges-facing-rural-pharmacies/

Kaiser Health News

As California Taps Pandemic Stockpile for Bird Flu, Officials Keep Close Eye on Spending

Published

on

kffhealthnews.org – Don Thompson – 2024-11-14 04:00:00

SUMMARY: California is using state and federal stockpiles to provide up to 10,000 farmworkers with safety gear as the state reports 21 human cases of bird flu. The state began distributing protective equipment in May and has confirmed bird flu at over 270 dairies. Drawing lessons from the COVID-19 pandemic, California is improving emergency responses and maintaining a stockpile that includes millions of face masks. However, due to financial constraints, funding for disaster supplies has been cut, and some preparedness programs were reduced or eliminated. A ballot measure to increase pandemic preparedness funding failed after its key financial supporter was convicted.

Read the full article

The post As California Taps Pandemic Stockpile for Bird Flu, Officials Keep Close Eye on Spending appeared first on kffhealthnews.org

Continue Reading

Kaiser Health News

After Congress Ended Extra Cash Aid for Families, Communities Tackle Child Poverty Alone

Published

on

kffhealthnews.org – Kate Wells, Michigan Public – 2024-11-14 04:00:00

SUMMARY: Dr. Mona Hanna, a pediatrician in Flint, Michigan, is championing the Rx Kids program, a pioneering cash aid initiative that provides $1,500 mid-pregnancy and $500 monthly for a child’s first year to Flint families. Since its January launch, nearly all babies born in Flint are enrolled, aiding parents with essential needs like diapers and food. While Rx Kids aims to reduce poverty and inspire lawmakers and donors, challenges remain for expansion in underserved regions like Michigan’s Upper Peninsula, where substantial private funding is needed. Ongoing efforts seek to raise awareness and secure resources for this impactful program.

Read the full article

The post After Congress Ended Extra Cash Aid for Families, Communities Tackle Child Poverty Alone appeared first on kffhealthnews.org

Continue Reading

Kaiser Health News

California Dengue Cases Prompt Swift Response From Public Health Officials

Published

on

kffhealthnews.org – Claudia Boyd-Barrett – 2024-11-12 04:00:00

SUMMARY: Jason Farned and his team at the San Gabriel Valley Mosquito and Vector Control District have been preparing for dengue’s arrival, with the virus now detected in California. The spread of Aedes mosquitoes, capable of transmitting dengue, has been fueled by climate change and international trade. In 2023, California saw 13 locally acquired cases, prompting efforts like surveillance, pesticide applications, and public education. Authorities are also exploring techniques like sterile mosquito releases to reduce populations. Public cooperation is key, as Aedes mosquitoes are now established in 24 counties, and local outbreaks pose a growing threat to public health.

Read the full article

The post California Dengue Cases Prompt Swift Response From Public Health Officials appeared first on kffhealthnews.org

Continue Reading

Trending