Thank you for the writeup. As usual when I read your analysis, I am stepping into a new realm of knowledge. How do we fix this wild west of healthcare insurance signups?
Bill, the most basic step is a tech fix that requires some kind of client input before an agent can make changes on an application (or complete a new one). The SBMs require this, and CMS promises it will make a change, but it's reluctant to do so in a way that slow up agents working legitimately. Meanwhile, both CMS and at least some state insurance departments are ramping up enforcement. HAFA, an agent trade group, has posted a fraud reporting page, with template affidavits for affected clients to sign, as the affected plan holder has to be involved in a fraud report. I have also seen a letter from Aetna to agents stating that they will cut off agent authorization to sell Aetna at the first whiff of fraud.
I do suspect (hope) that fraud incidence will start to go down in OEP 2025, as everyone's radar is up, and agents have to put their name on any fraudulent app to get paid. But CMS is not moving as fast as many would like on the tech fix.
Keep this issue front and center, Andy! 50,000 unauthorized enrollments in the first 3 months of 2024???-Unacceptable.
Andrew:
Thank you for the writeup. As usual when I read your analysis, I am stepping into a new realm of knowledge. How do we fix this wild west of healthcare insurance signups?
Bill, the most basic step is a tech fix that requires some kind of client input before an agent can make changes on an application (or complete a new one). The SBMs require this, and CMS promises it will make a change, but it's reluctant to do so in a way that slow up agents working legitimately. Meanwhile, both CMS and at least some state insurance departments are ramping up enforcement. HAFA, an agent trade group, has posted a fraud reporting page, with template affidavits for affected clients to sign, as the affected plan holder has to be involved in a fraud report. I have also seen a letter from Aetna to agents stating that they will cut off agent authorization to sell Aetna at the first whiff of fraud.
I do suspect (hope) that fraud incidence will start to go down in OEP 2025, as everyone's radar is up, and agents have to put their name on any fraudulent app to get paid. But CMS is not moving as fast as many would like on the tech fix.