H.R. 2079: Insurance Fraud Accountability Act

The Insurance Fraud Accountability Act aims to amend the Patient Protection and Affordable Care Act (ACA) to reduce fraudulent enrollments in health plans. Here’s a breakdown of the key aspects of the bill:

1. Focus on Fraudulent Enrollment

The bill introduces stricter rules and penalties specifically for agents and brokers who help individuals enroll in health plans. If a broker or agent knowingly provides false information or does not meet certain standards, they face severe financial penalties and even criminal charges.

2. Penalties for Agents and Brokers

- **Civil Penalties**: Agents or brokers found negligent in providing correct information could face fines ranging from $10,000 to $50,000 for each individual application where incorrect information was provided.- **Severe Violations**: Those knowingly submitting false information could be fined up to $200,000, along with potential criminal penalties that include fines or imprisonment for up to 10 years.

3. Consumer Protections

The bill establishes various consumer safeguards during the enrollment process:- **Verification Process**: The Secretary of Health and Human Services will create a verification process for new enrollments in health plans. This may include collecting proper documentation and ensuring that agents have consent from individuals for enrollment changes.- **Timely Notifications**: Individuals must be informed about any changes to their coverage or agent of record, ensuring they can take action if needed.- **Access to Information**: Enrollees should have easy access to their account information and details relating to their enrollment through a web platform or hotline.

4. Reporting Requirements

The bill modifies reporting guidelines where agents and brokers have to notify the Secretary about the termination of any health insurance issuers they are associated with.

5. Regulation of Marketing Organizations

- The bill requires states to develop criteria for regulating agents and brokers, especially those working with third-party organizations that aid in enrollment. This includes ensuring that marketing practices are straightforward and do not mislead consumers.- Agents and brokers must adhere to a standard of conduct prioritizing the best interests of enrollees.

6. Oversight and Audits

The Secretary will implement oversight measures that involve periodic audits of agents and brokers based on complaints or suspicious enrollment patterns, which may indicate fraud. These audits will help enforce compliance with federal and state laws.

7. Transparency in Practices

The bill aims to enhance the transparency of agents’ and brokers’ activities by maintaining a list of those who have been suspended or terminated from their roles, making it accessible to qualified health plans and relevant state departments.

Relevant Companies

None found.