September 26, 2013

There’s Potential for Fraud in the Exchanges? Who Knew!

We’ve been expressing concern about exchange-related fraud for a while now and this week we were glad to welcome the Obama Administration to the bandwagon. On Wednesday, Attorney General Eric Holder, Health and Human Services (HHS) Secretary Kathleen Sebelius and Federal Trade Commission (FTC) Edith Ramirez met at the White House to discuss their strategies and commitment to protect against fraud attempts related to the health insurance exchanges that are set to open on October 1.

So far, the Administration has set up several consumer protections such as readying the federal exchange call centers for people to report suspected fraud and allowing people to report problems to the FTC through the website. The Administration has also established a rapid response mechanism for addressing privacy or cyber security threats and is ramping up public education to empower consumers and assisters to know the facts and avoid scams. The Office of the Inspector General issued a consumer alert this week, highlighting some red flags consumers should watch for. The alert warned consumers against people who ask for money to enroll them in exchanges, high-pressure visits, mail solicitations, e-mails and phone calls from people claiming to work for the government. They also caution against speaking to people you did not contact who request personal information, scam websites and a reminder that Medicare beneficiaries do not need to buy coverage through the exchanges. If consumers do suspect fraud, they can report fraud activity to 1-800-318-2596.

Meanwhile, the House Energy and Commerce Committee took its final pre-open enrollment stab at the Administration when Director of CMS’ Center for Consumer Information and Insurance Oversight (CCIIO) Gary Cohen testified before the committee. Unsurprisingly, House Republicans questioned the Administration’s readiness for October 1 and Gary Cohen repeatedly reassured them “It’s my understanding and expectation — and I’m confident — that we will have [the exchanges] happening October 1.” Cohen also said that with any program, everyone should expect some bumps in the road in the early days of implementation.

House Republicans on the committee questioned if anyone would be able to see the exchange interface prior to October 1. Cohen acknowledged that it was unclear whether or not those working on the exchanges would have access to the interfaces prior to the start of open enrollment. He also assured the committee that rates in the federally facilitated marketplaces would be released “soon.” With just 11 days to go, we certainly hope so!


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