“To amend the Patient Protection and Affordable Care Act to reduce fraudulent enrollments in qualified health plans, and for other purposes.”
No CRS summary available for this bill.
This section amends verification penalties under ACA §1411(h) to establish civil penalties for agents or brokers who negligently provide incorrect information on Exchange applications of $10,000-$50,000 per individual and, for knowing violations, up to $200,000 per individual (with procedures mirroring Social Security Act §1128A); and adds criminal penalties of a fine under 18 U.S.C., imprisonment for up to 10 years, or both, for those who knowingly and willfully provide false or fraudulent information. The section further amends ACA §1311(c) to require the Secretary, for plan years beginning no later than January 1, 2029, in federally-facilitated Exchanges, to establish a verification process for agent- or broker-assisted enrollments and coverage changes eligible for commissions that includes (1) documentation of enrollee consent (e.g., standardized form); (2) delaying commissions until inconsistencies are resolved; (3) making required information accessible to qualified health plans via database; (4) timely notices to individuals of changes with cancellation instructions; (5) enrollee access to account details (including agent of record and plan changes) via website or hotline; and (6) agent/broker reporting of third-party marketing organizations.