Bill · S. 976· Senate(119-S-976)
Insurance Fraud Accountability Act
- Introduced
- 3/12/2025
- Last activity
- 11/6/2025 — Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.
- Sponsored by
- Ron Wyden
- Cosponsors
- - 11 - 0
- Introduced
- In Committee
What this bill would do
The Insurance Fraud Accountability Act aims to amend the Patient Protection and Affordable Care Act to reduce fraudulent enrollments in qualified health plans. The bill introduces strict civil and criminal penalties for agents and brokers who provide incorrect, false, or fraudulent information. It establishes a new verification process for enrollments and changes in coverage to ensure consumer consent. Additionally, the legislation creates oversight for marketing organizations and requires the Secretary to implement audit processes. These measures are intended to increase transparency and accountability within the health insurance enrollment process.
Yes· 3 of 7
Does this strengthen the Affordable Care Act?+6
The bill amends the ACA to better protect enrollees from fraudulent enrollment practices.
Does this make what the government does easier for the public to see?+5
The bill enhances transparency by requiring notification of enrollment changes and providing access to account information.
Does this give people more protection from unfair business practices?+5
The bill strengthens consumer protections by establishing stricter verification processes for health insurance enrollments.
The opposite
Would business owners be better off under this?-5
Insurance agents and brokers face significant new civil and criminal penalties and administrative burdens.
Who it would affect, and how
Potential Positive Impacts for People
- Increased Accountability for Agents and Brokers: The bill establishes civil penalties of not less than $10,000 and up to $50,000 for failures caused by negligence or disregard of rules, as well as penalties up to $200,000 for knowing violations (Section 2(a)).
- Criminal Deterrence: Agents or brokers who willfully provide fraudulent information could face fines and imprisonment for up to 10 years (Section 2(a)).
- Verification of Consent: The bill requires a verification process for new enrollments or coverage changes that includes documentation or evidence, such as a standardized consent form, to prove the individual has consented (Section 2(b)(1)(A)(ii)).
- Timely Notifications: Individuals must be notified of changes to their enrollment, coverage, agent of record, or premium tax credits in a timely manner, including plain language instructions on how to cancel unauthorized activity (Section 2(b)(1)(A)(ii)(iv)).
- Improved Access to Information: Consumers can access their account information, including details on their agent of record and health plan, through a website or telephone hotline (Section 2(b)(1)(A)(ii)(v)).
- Continuity of Care: The enrollment verification process is required to prioritize continuity of coverage and care by not disenrolling individuals without their consent (Section 2(b)(1)(C)).
- Standard of Conduct: The bill mandates that agents and brokers 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)).
- Oversight Through Audits: The Secretary will implement a process for oversight and enforcement, including periodic audits based on consumer complaints or enrollment patterns that suggest fraud (Section 2(d)(2)(A)).
Potential Negative Impacts for People
- Financial Penalties for Negligence: Agents or brokers can be subject to civil penalties between $10,000 and $50,000 if they fail to provide correct information due to negligence or disregard of rules (Section 2(a)(1)(C)(ii)).
- High Penalties for Knowing Violations: Those who knowingly provide false or fraudulent information can face civil penalties of up to $200,000 per individual (Section 2(a)(1)(B)(ii)(I)).
- Potential Imprisonment: Agents or brokers who willfully provide fraudulent information face the risk of imprisonment for up to 10 years (Section 2(a)(3)).
- Delayed Commissions: Under the new verification process, commissions due to a broker or agent may only be paid after an enrollee has resolved all information inconsistencies (Section 2(b)(1)(A)(ii)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Hover a score for the reason it gave.
- Healthcare
- Increases Affordable Care Act Support+6Improves Healthcare Access+4
- Governance And Ideology
- Improves Government Transparency+5Increases Federal Power+3
- Economy And Finance
- Improves Consumer Protection+5
- Demographic And Interest Groups
- Good For Low Income Households+4Good For Middle Class Households+2Good For Business Owners-5
- 3/17/2026
- 1 Cosponsor added.
- 11/6/2025
- Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.
- 11/5/2025
- 1 Cosponsor added.
- 3/12/2025
- Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 9 Cosponsors added.
- Introduced in Senate
4 bills Congress.gov lists as related to this one — companions in the other chamber, earlier versions, and bills this one absorbed or was folded into.
Richard BlumenthalDemocrat · Connecticut
Tammy DuckworthDemocrat · Illinois
Mazie HironoDemocrat · Hawaii
Amy KlobucharDemocrat · Minnesota
Patty MurrayDemocrat · Washington
Jeanne ShaheenDemocrat · New Hampshire
Brian SchatzDemocrat · Hawaii
Tina SmithDemocrat · Minnesota
Chris Van HollenDemocrat · Maryland
Raphael WarnockDemocrat · Georgia
Peter WelchDemocrat · Vermont