May 21,2024

Wyden Urges CMS to Crack Down on Fraudulent Health Plan Changes

Finance Chairman Pledges Legislative Action to Hold Brokers and Insurance Agencies Criminally Responsible for Fraud

Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure urging CMS to enforce civil monetary penalties established by Congress on brokers who submit fraudulent enrollments for a health plan. The senator also urged CMS to take additional steps, such as providing clear rules and guidelines on what marketing practices are acceptable, so working Americans in need of accessible, affordable health coverage are protected and enrolled in a plan they chose. 

“I write to express my outrage with reports that agents and brokers are submitting plan changes and enrollments in the Federal marketplace without the consent of the people who rely on these plans,” Wyden wrote. “These plan changes and enrollments result in tangible harm to people including uncovered medical expenses, loss of coverage, and disruptions in care, and an unexpected tax liability that could be thousands of dollars out of their own pockets. In my view, the brokers, agencies, and lead generators participating in fraudulent enrollment schemes should be held criminally responsible. I tend to introduce legislation to give you this authority.”

Bad actor agents and deceptive marketing practices are not new. The Trump administration focused on privatizing the Affordable Care Act (ACA) marketplace by introducing enhanced web-broker platforms that have allowed brokers to bypass the ACA marketplace’s benefits and protections. These bad actors could increasingly gain access to Americans’ information  and change their health insurance plans while leaving consumers and their legitimate brokers in the dark. Bad actors’ plan changes and fraudulent enrollments have harmed consumers, including uncovered medical expenses, loss in coverage, disruptions in care, and unexpected tax liability that could be thousands of out-of-pocket dollars.

The letter to CMS can be found here.