Federal regulators have blocked two private sector enrollment websites from accessing consumer information through the federal Obamacare marketplace, citing \u201canomalous activity.\u201d<\/p>\n
The unusual step comes as the Centers for Medicare & Medicaid Services is under the gun to curb unauthorized enrollment and switching of Affordable Care Act plans by rogue agents. The agency received more than 200,000 complaints in the first six months of the year about such actions.<\/p>\n
CMS said in a written statement that it had suspended the two sites \u2014 Benefitalign and Inshura \u2014 \u201cwhile the anomalous activity is researched to ensure the EDE partners are in compliance with CMS data standards.\u201d EDE stands for \u201cenhanced direct enrollment\u201d and refers to websites approved to integrate with healthcare.gov.<\/p>\n
In a separate development, the two websites, which insurance brokers use instead of the federal healthcare.gov site to enroll clients in Affordable Care Act plans, are mentioned in an ongoing civil lawsuit filed by attorneys representing consumers and agents who claim they\u2019ve been harmed by enrollment schemes.<\/p>\n
CMS posted on Aug. 9<\/a> an updated list of websites approved to integrate with the federal Obamacare marketplace that no longer included Benefitalign and Inshura. As a result, insurance agents can\u2019t use the websites to enroll customers in or make changes to their Obamacare plans.<\/p>\n Private sector enrollment sites were first allowed to integrate with healthcare.gov data under the Trump administration. About a dozen such sites are now approved to connect with the federal system.<\/p>\n Thwarting enrollment schemes and rogue insurance agents without making it too difficult for consumers and legitimate agents to enroll in health plans has become a political problem<\/a> for the Biden administration. President Joe Biden has claimed record-breaking enrollment under the ACA as one of his administration\u2019s major accomplishments.<\/p>\n In recent weeks, lawmakers have called on CMS<\/a> to do more and introduced legislation to increase penalties for agents who enroll people in plans without authorization. The large number of complaints from victims of the schemes have caught the attention of House Republicans, who on June 28 requested investigations by the Government Accountability Office<\/a> and the Office of Inspector General<\/a> at the Department of Health and Human Services.<\/p>\n KFF Health News began reporting on ACA enrollment schemes<\/a> early this year.<\/p>\n CMS has since taken actions to short-circuit unscrupulous agents and call centers.<\/p>\n Until last month, agents using the approved private sector enrollment sites could access consumer information via healthcare.gov with only a name, birth date, and state of residence. CMS now requires<\/a> three-way calls among agents, consumers, and the healthcare.gov helpline when agents new to a policy try to make a change. Many legitimate insurance agents are urging an additional fix used widely by state Obamacare enrollment systems: requiring two-factor authentication before consumer information can be accessed or changed by agents.<\/p>\n Meanwhile, the move to suspend the two enrollment websites baffled the companies, said Catherine Riedel, a spokesperson for TrueCoverage, an insurance call center that also does business as Inshura. TrueCoverage and Benefitalign are subsidiaries of Speridian Global Holdings of California.<\/p>\n \u201cWe don\u2019t know what they want us to do differently,\u201d she said.<\/p>\n The websites, she said, are cooperating with CMS, and they conducted an internal review that found no security issues. Very few details, other than \u201cit is related to a potential technical anomaly reported by an outside party\u201d were given, Riedel wrote, and the firms have not been provided \u201cany specific, actionable information related to the alleged anomaly.\u201d<\/p>\n Both firms are mentioned in the lawsuit first filed in April in the U.S. District Court for the Southern District of Florida. The suit alleges that people and organizations engaged in misleading advertising, or made changes to ACA policies, without the express permission of consumers \u2014 all with a goal of racking up commissions.<\/p>\n Late on Aug. 16, that case was amended to add<\/a> allegations and defendants, including Benefitalign. The other enrollment website, Inshura, is not listed as a defendant, although it is run by TrueCoverage, which is.<\/p>\n Riedel said TrueCoverage disputes the lawsuit\u2019s claims.<\/p>\n The case \u201cis founded on misinformation and technical naivety that seems to have been connected to create a sensational and false narrative,\u201d she said.<\/p>\n The Aug. 16 filing alleges that TrueCoverage or Speridian Technologies, another subsidiary of Speridian Global Holdings, used the Benefitalign or Inshura websites to access U.S. consumers\u2019 personal information, then sent it to marketers in India and Pakistan. The allegation, if true, would violate agreements the private sector websites made with the federal government to gain approval to operate, the suit contends.<\/p>\n Riedel said there is no evidence to support the allegations and that it is technically impossible to move \u201cbulk amounts of consumer data\u201d from the Obamacare marketplace.<\/p>\n \u201cLike many technology companies, some of TrueCoverage\u2019s marketing efforts have been based in India. However, as part of that marketing work, TrueCoverage did not move any customer data out of the EDE platform,\u201d she said.<\/p>\n The 185-page amended complaint added as a defendant Bain Capital Insurance Fund, part of one of the world\u2019s leading private investment companies, saying it \u201caided and abetted\u201d Florida-based Enhance Health<\/a>, which describes itself as a large broker of ACA plans. Bain helped launch Enhance with a $150 million investment in 2021<\/a> and appointed its CEO.<\/p>\n After initially planning to market Medicare Advantage plans, the lawsuit says, Enhance Health and Bain decided to shift to ACA plans, which were seen as more profitable. The suit alleges Enhance Health participated in unauthorized agent changes or switching of ACA policies.<\/p>\n Bain knew \u201cwhat was going on\u201d at Enhance \u201cand ultimately supported it,\u201d the lawsuit says, noting that Bain executives sat on Enhance\u2019s board, controlled the hiring of executives, and were often at its Sunrise, Florida, offices. The firm hoped to sell the company once it showed how profitable it could be, the suit alleges.<\/p>\n In a written statement, Enhance Health said that \u201cupholding the highest standards of compliance and controls is a core focus in all aspects of our operation and we will vigorously defend against these baseless claims.\u201d<\/p>\n Bain Capital Insurance did not reply to a request for comment.<\/p>\n The additional allegations expand on the initial April filing,<\/a> which outlined a complex web of activities aimed at capitalizing changes to the ACA under Biden that resulted in broader availability of zero-premium plans for lower-income applicants. In some cases, consumers were lured to call centers through misleading ads touting nonexistent cash cards. Some call centers or agents filed duplicate coverage for the same individuals, without consumer permission, or split family members among multiple policies, the suit alleges.<\/p>\n Because the customers don\u2019t pay monthly premiums for the plans, they may not notice they\u2019ve been enrolled until they try to obtain care.<\/p>\n Some consumers whose plans were switched lost access to their doctors or medications. Some face tax consequences<\/a> if they were enrolled in duplicative coverage or in subsidized plans for which they did not qualify.<\/p>\n One victim added to the case, Paula Langley of Texas, initially responded to an advertisement promising a cash card. She called the number advertised and was enrolled in ACA coverage in February 2023 but never received the promised incentive, according to the lawsuit.<\/p>\n She and her husband began receiving multiple insurance cards from different insurers, the suit says. She would show up for a doctor\u2019s visit or to pick up a prescription only to find her coverage had been canceled, leaving her with unpaid medical bills.<\/p>\n All in all, she was switched among plans and agents at least 22 times in just over a year, the lawsuit alleges<\/a>.<\/p>\n Attorneys Jason Kellogg of Miami and Jason Doss of Atlanta said they amended the lawsuit based on dozens of interviews with former employees of the named firms. They\u2019re seeking class-action status on behalf of affected consumers and agents who have lost business to the unauthorized plan-switching, and the suit alleges violations of the federal Racketeer Influenced and Corrupt Organizations \u2014 or RICO \u2014 Act<\/a>.<\/p>\n \u201cThe scheme is bad enough because it\u2019s so large,\u201d Kellogg said. \u201cBut it\u2019s much worse given that it preys upon Americans who are at the lowest levels of the income scale, who may be desperate, are most vulnerable.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n