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Interagency Initiative Targets Consumer Fraud in the ACA Exchange Marketplace

Written by:  Carrie A. Roll

Yesterday, the Attorney General, the Secretary of the Department of Health and Human Services (HHS), and the Chairwoman of the Federal Trade Commission (FTC) announced an interagency initiative to prevent consumer fraud and privacy violations in connection with the Affordable Care Act’s Health Insurance Marketplace.  Open enrollment for the Marketplace begins on October 1st.

Officials noted that the initiative builds on a successful consumer fraud infrastructure that already exists and highlighted that the new initiative will:

  • Dedicate a Marketplace Call Center as a resource and referral to FTC for consumer fraud concerns, with trained staff to refer consumer threats and complaints;
  • Connect consumers to FTC’s Complaint Assistant through;
  • Develop a system of routing complaints through the FTC’s Consumer Sentinel Network for analysis and referral as appropriate;
  • Establish a rapid response mechanism for addressing privacy or cybersecurity threats; and
  • Ramp up public education to empower consumers to know the facts and avoid scams.

The interagency initiative was announced amid the release of a report by the House Committee on Oversight & Government Reform (Report) that identified significant fraud and abuse risks associated with the navigator and in-person assistance programs, which are designed to help consumers enroll in the Marketplace.  Among other shortcomings, the Report found a substantial risk of consumer fraud due to the Obama Administration’s failure to require background checks and fingerprinting of individuals hired by navigator and assister organizations.  The Report also noted that there is no mechanism in place for consumers to determine if navigators and assisters are legitimate.

HHS also held a podcast aimed at educating consumers on the warning signs of fraud within the Marketplace.  Potential warning signs include:

  • People asking for money to enroll an individual in the Marketplace or “Obamacare” insurance.  HHS stated that legitimate enrollment assisters will not ask for money.
  • High-pressure visits, mail solicitations, emails, and phone calls from people who say they work for the government and who threaten legal action if an individual does not sign up for a plan.
  • People whom an individual did not contact requesting personal information. HHS noted that no one from the government will call or email an individual to sell an insurance plan or ask for personal identifying information.
  • Sham websites (i.e., websites that do not have official government seals, logos or website addresses).

Robert Kidwell, a Member of Mintz Levin’s Antitrust Practice, notes that this initiative is “consistent with the FTC’s heightened focus in recent years on protecting healthcare consumers, whether from inflated prices due to anticompetitive practices or from deceptive or fraudulent practices ranging from dietary supplement claims to health-related marketing schemes.”

With the launch of the ACA Exchange Marketplace less than two weeks away, it is clear that the Obama Administration is ramping up efforts to reassure Americans about the privacy and security of the information submitted to the Marketplace.  How successful the initiative will be remains to be seen.

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Theresa advises clients on all aspects of the pharmaceutical supply chain, including counseling industry stakeholders on a range of business, legal, transactional, and compliance matters. She provides clients with strategic counseling and creative business modeling that considers legal restrictions and regulatory risk in light of innovation and business goals.