Insurance Fraud Accountability Act

Increased Penalties for Misconduct: Agents or brokers who fail to provide correct information due to negligence face civil penalties of between $10,000 and $50,000 per individual (Section 2(a)(1)(C)). Those who knowingly provide false or fraudulent information face civil penalties up to $200,000 (Section 2(a)(1)(B)(ii)(I)) or criminal penalties including up to 10 years in prison (Section 2(a)(1)(3)).

Enhanced Enrollment Verification: The Secretary must establish a process that requires agents or brokers to provide documentation or evidence, such as a standardized consent form, to prove an individual has consented to a new enrollment or coverage change (Section 2(b)(1)(A)(B)(i)).

Improved Consumer Information and Access: Individuals will receive timely notifications regarding changes to their enrollment, coverage, agent of record, or premium tax credits, including plain language instructions on how to cancel unauthorized activity (Section 2(b)(1)(A)(B)(iv)). Additionally, people can access their account information through a website or technology platform to monitor changes to their plan or agent (Section 2(b)(1)(A)(B)(v)).

Protection Against Disenrollment: The enrollment verification process must prioritize continuity of coverage and care by not disenrolling individuals from a qualified health plan without their consent, even if a broker or plan is in violation of requirements (Section 2(b)(1)(C)).

Higher Standards for Marketing: Agents and brokers must act according to a standard of conduct that includes a duty to act in the best interests of the enrollee (Section 2(c)(1)(B)(i)). Furthermore, marketing materials and organizations are subject to stricter requirements to ensure they are not confusing or misleading (Section 2(c)(1)(B)(iii)).

Stronger Oversight and Audits: The Secretary will implement a process for oversight and enforcement that includes periodic audits of agents and brokers based on consumer complaints or patterns suggesting fraud (Section 2(d)(2)(A)(i)).