Senators urge CMS to crack down on fraudulent health plan changes

On Thursday, U.S. Sen. Ron Wyden (D-OR) urged the Centers for Medicare & Medicaid Services (CMS) to enforce penalties on brokers who submit fraudulent enrollments for a health plan.

Wyden, the chair of the Senate Finance Committee sent a letter to Chiquita Brooks-LaSure, CMS Administrator, urging CMS to enforce civil monetary penalties on any broker who engages in such fraudulent changes, and to take additional steps to ensure Americans can enroll in an affordable health coverage plan if they chose. Wyden said CMS should provide clear rules and guidelines on what marketing practices are acceptable.

“I write to express my outrage with reports that agents and brokers are submitting plan changes and enrollments in the Federal marketplace without the consent of the people who rely on these plans,” Wyden wrote. “These plan changes and enrollments result in tangible harm to people including uncovered medical expenses, loss of coverage, and disruptions in care, and an unexpected tax liability that could be thousands of dollars out of their own pockets. In my view, the brokers, agencies, and lead generators participating in fraudulent enrollment schemes should be held criminally responsible. I tend to introduce legislation to give you this authority.”

Wyden said privatization of the Affordable Care Act (ACA) marketplace during President Trump’s administration introduced web-broker platforms that allow brokers to bypass the ACA marketplace’s benefits and protections. These changes allowed bad actors to gain access to American’s information and change health insurance plans while leaving consumers and legitimate brokers in the dark. Those changes and fraudulent enrollments have harmed consumers, he wrote, leaving them with uncovered medical expenses, lost coverage, disruptions in care and unexpected tax liabilities that could amount to thousands of dollars.

Wyden also promised to introduce legislative action that would hold brokers and insurance agencies criminally responsible for fraud.

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