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Protect from Marketplace fraud

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With only 12 days until open enrollment begins on the Health Insurance Marketplace, Washington has geared up efforts to protect consumers by preventing and detecting potential fraud.

“Today, we are sending a clear message that we will not tolerate anyone seeking to defraud consumers in the Health Insurance Marketplace,” said Kathleen Sebelius, Health and Human Services secretary in a press release Wednesday.  “We have strong security safeguards in the Marketplace to protect people’s personal information against fraud and we will work with our partners to aggressively prosecute bad actors, just as we have been doing in Medicare, Medicaid and the Children’s Health Insurance Program.”

Federal officials acknowledged the potential for scams with any new government program, but stressed federally-paid enrollment advisors, called navigators, do not represent a significant risk and that Medicare has used such guides for years without problems or controversy.

Some lawmakers say they’re worried the online marketplace may put citizens’ privacy at risk.

"Exchange applicants will have to hand over Social Security numbers, birth dates, employment information, tax returns and much more," said state Rep. Matt Hudson, R-Naples, before a House Subcommittee meeting in Washington, D.C.. "All the information needed for identity theft."

State Sen. Eleanor Sobel, D-Hollywood said she’s worried for a different reason. Many Floridians don’t even know the Marketplace exists or how to use it, she said, citing restrictions placed by Gov. Rick Scott administration that prevents local health departments from allowing navigators into their offices.

"This is a desperate attempt to prevent access to those who need health insurance the most," she said.

The Obama administration announced Sept. 18th a comprehensive, interagency initiative to prevent, protect against and, if necessary, prosecute consumer fraud and privacy violations in the Marketplace.

Steps have been initiated to prevent and respond to individuals attempting to take advantage of the public during health care implementation.  These measures include:

  • Reporting fraud mechanism: A new feature of the Marketplace Call Center (1-800-318-2596) will now enable individuals to report fraud simply by calling the 1800 number. Call Center operators have been trained to take a fraud complaint, and refer them to FTC’s Consumer Sentinel Network.   
  • Creating new pathways: HealthCare.gov offers easy access to connect consumers to FTC’s Complaint Assistant.
  • Establishing a routing system for complaints through a centralized database: Routing complaints through FTC’s Consumer Sentinel Network will ensure federal, state and local law enforcement have access to consumer complaints and can analyze and refer those complaints as appropriate. 
  • Protecting personal data: Building on the certification of the Health Insurance Marketplace’s data hub on Sept. 6, 2013 as in compliance with the stringent security, privacy and data flow standards developed by the National Institute of Standards and Technology - the gold standard for information and independent security controls assessment - the interagency officials have also established a rapid response mechanism that will be employed in the unlikely event of a data security breach.
  • Empowering consumers with information: Building on a proactive effort to inform consumers about potential fraud and privacy threats, the federal government is releasing new educational materials to empower consumers and assisters who are helping consumers navigate the Marketplaces. They include online tip sheets like Protect Yourself from Fraud in the Health Insurance Marketplace and Tips for Assisters to Help Consumers Navigate the Marketplace. The materials remind consumers that there is assistance, at no cost to them, available to navigate the Marketplace and that they should be suspicious of persons who ask for a fee before providing assistance.

Resources to protect yourself against fraud

  1. Suspect a Health Care Scam? Here’s What to Do- Tips from the Federal Trade Commission, the nation’s consumer protection agency, on lines scammers may use and how to figure out what’s real.
  2. Protect Yourself from Fraud in the Health Insurance Marketplace- a tip sheet from HealthCare.gov helping consumers know what to expect and when to be suspicious.
  3. Tips for Assisters to Help Consumers Navigate the Marketplace- a tip sheet for navigators to engage their communities and safely enroll the uninsured.
  4. Information on Navigators and Registering- Guideline from Florida’ Chief Financial Officer on training navigators should complete and what they are prohibited from doing.
  5. Securing the Health Insurance Marketplace- Information on security measures from the Centers for Medicare & Medicaid Services.

Stop back by the FRHA blog Saturday for more health care exchange information.

Learn how the Affordable Care Act impacts rural Florida and the nation by registering for the FRHA 20th Annual Educational Summit held in Gainesville Nov. 20-22. Click here for check out the agenda and learn more.