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
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
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
- 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
- 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
Resources to protect yourself against fraud
- 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.
- 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.
- Tips for Assisters to Help Consumers Navigate the
Marketplace- a tip sheet for navigators to engage their communities and safely
enroll the uninsured.
- Information on Navigators and Registering- Guideline from
Florida’ Chief Financial Officer on training navigators should complete and
what they are prohibited from doing.
- 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.