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Patronis says his office has opened more than 900 investigations into ACA fraud


Patronis says his office has opened more than 900 investigations into ACA fraud

May 21, 2024 | 4:18 pm ET
By Mitch Perry
Patronis says his office has opened more than 900 investigations into ACA fraud
Florida Chief Financial Officer Jimmy Patronis. March 22, 2023. Credit: Department of Financial Services

Responding to complaints from Floridians who have either had their health care coverage added to the Affordable Care Act or switched without their consent, Florida Chief Financial Officer Jimmy Patronis has called upon Congress to crack down on allegedly fraudulent health insurance agents and brokers.

“The lack of security measures for the Affordable Care Act (ACA) Marketplace is impacting Floridians,” Patronis said in a statement on Tuesday, a day after he sent a letter to Vermont independent U.S. Sen. Bernie Sanders and Kentucky GOP Congressman Brett Guthrie, committee chairs overseeing the U.S. Center for Medicaid and Medicare Services (CMS).

“Policyholders are getting plans they didn’t want, or ask for,” Patronis added. “Thanks to the weak security measures of the Marketplace, Floridians are being signed up for health policies in different states, then getting penalized by the IRS because they made too much to qualify for plans. This fraud can only occur through a Marketplace that’s got more holes in it than a cheap slice of Swiss cheese.”

Unauthorized enrollment or plan-switching by “rogue” insurance agents is emerging as a serious problem for individuals signed up with the ACA, KFF Health News reported last month. Licensed agents can access a policyholder’s coverage through the federal exchange simply by entering a person’s name, date of birth, and state.

CMS received approximately 40,000 complaints of unauthorized plan switches during the first three months of 2024, the agency said in a news release earlier this month, with more than 97% of those complaints being resolved. And the agency received approximately 50,000 complaints of unauthorized enrollments in the first three months of 2024. Approximately 44,000 of these cases, or 88%, have been resolved, officials say.

“My agency is receiving an increase in consumer complaints related to Affordable Care Act (ACA) fraud,” Patronis wrote to Sanders and Guthrie.

“My office has opened over 900 investigations into unauthorized registration of consumers into ACA plans and instances where Florida consumers are switched from one ACA plan to another without their authorization, all so a bad actor can collect a commission.

“Consumers should never be surprised by their health coverage. While most businesses that offer online registration require two-factor authentication (2FA) to ensure consumers know what they are being signed up for, Centers for Medicaid and Medicare Services (CMS) does not. How is signing up for the ‘Uber’ app a more secure process than obtaining health care through the federal government?”

Patronis wants CMS to immediately begin requiring two-factor authentications for all changes to ACA accounts.

“A simple text or email message could save thousands of consumers from the IRS coverage denials,” he writes. “This is to say nothing of the millions of dollars in tax credits the federal government is currently spending on phony ACA enrollments.”

Florida leads the entire nation in signups to the Affordable Care Act marketplace, with more than 4.2 million residents signed up for the program as of this January, according to CMS.