Obamacare Fraud Targeted By New Federal Rule

Authored by Lawrence Wilson via The Epoch Times,

The Centers for Medicare and Medicaid Services has unveiled new regulations to strengthen the integrity of the Obamacare insurance exchanges and promote innovation.

The new federal rule, released for comment on Feb. 9, will lower the cost of health care, according to Secretary of the Department of Health and Human Services Robert F. Kennedy Jr.

“At President [Donald] Trump’s direction, [this agency] is driving down costs and rooting out fraud across our health insurance programs,” Kennedy said in a statement, predicting that the policy changes overall will reduce premiums and increase consumer choice.

Eligibility Verification

New anti-fraud regulations will require stronger enforcement of eligibility and income verification, correcting a situation that some observers say allowed unscrupulous insurance brokers to sign up millions of people for the program without their knowledge, particularly in plans with no premiums.

America’s Health Insurance Plans, the trade association for health insurance companies, has disputed that claim. However, 24 had more enrollees in Obamacare zero-premium plans in 2024 than they had qualifying residents, according to data from the think tank Paragon Health Institute.

The new regulations, once finalized, will require agents and brokers to use federally-approved forms for verifying enrollee eligibility and to obtain their consent for enrollment.

The regulations also make it clear what action a consumer must take to review and affirm their personal and eligibility information, and to signify their consent.

The rule would clarify which individuals qualify for Obamacare subsidies as “eligible noncitizens,” and would deny subsidies to those who are ineligible for Medicaid due to their immigration status.

Marketing Practices

A second program change prohibits certain marketing practices for agents and brokers who help customers sign up for Obamacare through the federal and state marketplaces.

Providing cash, cash equivalents, or monetary rebates to influence customers to enroll would be prohibited.

Also prohibited are falsely suggesting that customers would qualify for a zero-premium plan and misleading customers about enrollment deadlines.

“This proposal would ensure consumers are provided accurate information about the Exchange prior to enrollment, maintain the integrity of the exchanges, and foster trust between consumers and agents, brokers, and web-brokers,” according to the Centers for Medicare and Medicaid Services.

Payment Tracking

The new rule seeks to create an information security protocol for enrollees of the program as of 2024 to measure improper payments in the state-based exchanges.

Fraud, waste, and abuse costs the program up to $27 billion annually by some estimates, said Chairman of the House Ways and Means Committee Rep. Jason Smith (R-Mo.).

“This fraud can directly impact the legitimate needs of patients, who may face denied claims or delayed care when their providers struggle to verify which insurance is valid due to the chaos created by schemes like people using stolen identities to sign up for multiple plans,” Smith said in November.

Consumer Choice

Other provisions of the rule aim to expand consumer choice and bring down prices.

The draft of the policy permits insurance companies to offer catastrophic plans with terms from one to 10 years. Currently, customers must be either under 30 years old, ineligible for a subsidy for a marketplace plan, or have a hardship or affordability exemption.

The rule would expand hardship exemptions for people aged 30 and above to make catastrophic plans more accessible.

Also, insurers would be allowed to offer Obamacare plans that do not meet the standard plan requirements. Standardized plans have the same deductibles and cost-sharing, which makes it easier to compare various plans based on price and other factors.

The change aims to give issuers more flexibility to tailor plan options to their marketplaces.

“The goal is simple: lower costs, more choice, and exchanges that work as intended,” Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, said in a Feb. 9 statement.

The proposed regulations will be published in the Federal Register on Feb. 11 and open for comment for 30 days.