The Brokers And Insurer Engagement And Tolerance Of Fraud
Fraudulent activity can often be found as approved brokers work within the system, such as through enhanced direct enrollment. In enhanced direct enrollment, brokers host their own eligibility applications and send enrollment information to Healthcare.gov. This is unlike traditional direct enrollment platforms, where brokers send enrollees to Healthcare.gov to file their eligibility application directly, then return to the broker’s site to select a health plan. Enhanced direct enrollment platforms often miss critical information — like Social Security numbers — yet made up 81 percent of all broker-assisted enrollments in 2023.
In online ads on Facebook and other platforms, unscrupulous agents and brokers lure Americans to hand over their personal information with promises like: “[P]ut $6,400 in your pocket right now for free.” The agents then use that information to enroll people in ACA coverage, even if they did not consent to signing up for insurance. One consumer, Angela Wells, clicked on one ad that promised cash cards for groceries. Even though she refused to sign up for insurance over the phone, the agent switched her plan anyway. She found out only when her pharmacy said her insurance had been cancelled and replaced with a plan—one with significantly higher copayments.