A key senator is calling on the Centers for Medicare & Medicaid Services (CMS) to crack down on brokers who submit fraudulent enrollments for Affordable Care Act (ACA) plans.
Sen. Ron Wyden, D-Oregon, wrote in a letter (PDF) to the agency expressing concern about reports that brokers are making enrollments or changes to plans without consent from enrollees. Wyden said these actions "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 the letter, Wyden argues that CMS should enforce civil monetary penalties for brokers who fraudulently submit plan enrollments, penalties that currently exist in the ACA. Wyden said he intends to introduce legislation that would hold these brokers accountable criminally as well.
Wyden also said CMS should go further by establishing guidance that outlines acceptable marketing practices.
"Access to affordable health coverage is necessary for good health and should not be exploited by fraudsters to collect illicit commissions at the expense of working Americans," Wyden wrote.
He added that these reported behaviors are "not new," as brokers gained access to enhanced, web-based platforms in the Trump administration that allowed them to "bypass the benefits and protections of the ACA marketplace."
"Stakeholders have informed my staff that this problem has become widespread and more sophisticated in the ACA marketplace as bad actors with access to a consumer’s eligibility information through web-broker platforms can make plan and agent-of-record changes while keeping people and their legitimate brokers in the dark," Wyden said.