""These marketers falsify information to get Medicaid coverage denied, then use that denial to open a Special Enrollment Period and falsify income to move people into subsidized ACA marketplace plans with the fraudsters as agents of record.""
""Throughout that year that they are the agent of record, they are now changing these individuals' health plans on a daily, weekly and monthly basis, generating commissions every time that they enroll in a new plan.""
""This leads to care being disrupted and oftentimes not being covered due to changes in insurance. It then affects access to medications for mental health, opioid addiction and HIV, as these individuals are now incurring a cost that they can't afford.""
The U.S. Department of Justice is addressing fraud in the Affordable Care Act Marketplace, particularly affecting vulnerable populations like the homeless and those with mental health issues. Fraudsters, referred to as 'street marketers,' manipulate Medicaid coverage denials to enroll individuals in subsidized ACA plans without their consent. This leads to frequent changes in health plans, disrupting care and access to necessary medications. The administration's Crushing Fraud, Waste and Abuse initiative aims to combat such fraudulent activities across various health programs.
Read at MedCity News
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