ACA fraud crackdown could slow signups: 4 things to know

Federal efforts to prevent fraud in the ACA marketplace are yielding positive results, but new restrictions aimed at curbing fraud may complicate the 2024 open enrollment period, KFF Health News reported Nov. 25. 

Here are four things to know: 

  1. Federal regulators reported a nearly one-third reduction in complaints about unauthorized plan switching, indicating that efforts to address fraud are working. Through August, more than 274,000 consumer complaints were filed, but recent actions have contributed to a significant decline in fraudulent activity. 

  2. CMS has introduced stricter rules for changing plans, such as requiring a three-way call involving the consumer, broker and a healthcare.gov representative when an agent is not affiliated with the existing plan. This aims to reduce fraud but may add delays to the enrollment process, according to the report. 

  3. CMS has suspended 850 agents suspected of being involved in unauthorized switching. While this action is intended to curb fraud, it has raised concern from agent groups who argue that some agents were suspended without due process, and the additional restrictions could further complicate the enrollment experience for consumers. 

  4. The ACA open enrollment period began Nov. 1, and experts warned that the added anti-fraud measures could slow the sign-up process. Consumers may face longer wait times for the necessary three-way calls or encounter difficulties finding new agents due to suspensions, according to the report.

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