NEWSROOM

Kaiser Health News reported last week on a proposal by Sen. Ron Wyden (D-Oregon) to criminally charge health insurance brokers who fraudulently enroll consumers in Affordable Care Act (ACA) health plans.
 
Under the legislation, brokers and agents could be subject to civil penalties – of $10,000 to $200,000 – plus criminal penalties. There have been increasing reports this year of efforts to falsely enroll individuals in the federal enrollment system to earn commissions paid by insurers participating in the federal ACA marketplace.
 
“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,” Sen. Wyden said in a statement.
 
According to the U.S. Centers for Medicare & Medicaid Services (CMS), more than 200,000 people have complained this year about unauthorized ACA marketplace enrollment or plan switches.
 
The legislation introduced by Sen. Wyden is co-sponsored by Democratic Sens. Sherrod Brown (Ohio), Tammy Duckworth (Illinois), Patty Murray (Washington), Brian Schatz (Hawaii), and Chris Van Hollen (Maryland). It asks federal regulators to verify consumer agreement to any ACA enrollment or plan switch. It also calls for consumers to be notified of any change to their ACA coverage.
 
CMS says it is implementing a block for ACA exchange policies to prevent changes unless the requesting broker is already associated with the consumer’s plan. If an agent cannot prove an association, additional steps will need to be taken to ensure the consumer has authorized the requested change.
 
A deputy administrator at CMS and the director of its Center for Consumer Information and Insurance Oversight, Ellen Montz said in a written statement to Kaiser Health News, “CMS will do everything it can to protect consumers from bad actors and will assist consumers who have experienced a change that they didn’t authorize.”
 
One of the largest private companies used by brokers to enroll consumers in ACA exchange plans said it plans to work with insurance companies to prevent authorized sign-ups and changes. It will cut off commissions for brokers considered unscrupulous because of unauthorized ACA plan enrollments or changes.