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| Do they print $6,400 bills? |
The outbreak of large-scale agent fraud in the ACA marketplace, in which agents have switched marketplace enrollees from one plan to another without their authorization or in some cases their knowledge, or have newly enrolled people without their consent or knowledge, has agents and the trade groups that represent them up in arms. There are multiple good reasons for this: their clients are harmed (as the plans they think they’re enrolled in are cancelled), the integrity of the marketplace as a whole is compromised — and their own incomes are denuded, as their commissions are terminated in favor of a new agent of record.
Much of the unauthorized (or inadequately authorized) plan-switching and enrollment appears to be straight-out fraud, along the lines alleged in a putative class action (Conswallo Turner et al. v. Enhance Health, LLC et al.): Leads generated by ads that misrepresent marketplace premium subsidies as cash benefits, fed to agents in call centers who obtain the minimal personal information needed (name, D.O.B. and state*) to switch the enrollee’s plan (or newly enroll her) with a new agent listed as the Agent of Record, without the enrollee’s understanding or consent. (CMS requires agents to obtain consent before acting on an account, and recently clarified that mere check-box consent is “likely not be sufficient to meet…new requirements,” but that soft prohibition seems to have been honored largely in the breach.)
Egregious fraud is happening. But the ease with which agents can alter or create an account on an EDE and collect a commission, coupled with the millions of people eligible for multiple zero-premium plans, further coupled with ads that are misleading to varying degrees, suggests a broader gray area in which some agents may be misleading marketplace enrollees to varying degrees.
