Health exchanges ripe for fraud, scams


State and federal health insurance exchanges rank high on the list of top 10 healthcare fraud areas of 2014, according to a new report by Bloomberg BNA.

With much of the public stymied by the complexities of buying health insurance, marketing scams have multiplied since the exchanges opened pursuant to the Affordable Care Act. Consumer groups counseled people to take precautions against identity theft. And the federal government took steps to protect consumers by opening a call center for fraud reporting, initiating a rapid response system to address information privacy and security breaches and distributing an anti-fraud tip sheet, as FierceHealthPayer reported.

Still, egregious schemes persist, according to the Coalition Against Healthcare Fraud. Phony salespeople and navigators, for instance, sell bogus insurance, charge illegal sign-up fees and obtain victims' financial information for ill use.

ACA critics have faulted the Obama Administration for failing to certify navigators and therefore make it harder for fraudsters to impersonate them, FierceHealthPayer noted.

Fake exchange websites disguised to look official dupe people into divulging financial and other sensitive information. Fraudulent email campaigns connect recipients to fake websites or install malware on their computers, according to the coalition. And bogus insurance sales can rob new customers from health insurers selling products on the exchanges.

What the federal government will ultimately do in response to schemes such as these remains unclear, Bloomberg BNA noted. Unanswered questions include: How high a priority will exchange-related fraud cases be for federal investigators? And will the government begin debarring individuals from participation in federal programs as a result of ACA-related fraud?

But throwing people out of government programs isn't always a guaranteed fix, since recent news reveals the ousted sometimes manage to commit more fraud later. For example, an owner of three home care agencies previously debarred from government programs has been accused of stealing $75 million from Medicaid, as FierceHealthPayer reported.  

For more:
- here's a free trial of BNA's report (.pdf)
- read the Coalition Against Healthcare Fraud article

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