“A bill 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 civil penalty provisions applicable to incorrect information provided during ACA enrollment verification (42 U.S.C. 18081(h)(1)) to (1) impose penalties of $10,000-$50,000 per individual, in addition to other penalties, on agents or brokers whose negligence or disregard of rules results in incorrect information under specified ACA provisions; and (2) impose penalties of up to $200,000 per individual, in addition to other penalties and with procedures mirroring those under SSA section 1128A, on agents or brokers who knowingly provide false or fraudulent information under those provisions; and (3) establish criminal penalties of fines under 18 U.S.C., imprisonment for up to 10 years, or both for agents or brokers who knowingly and willfully provide such information. The section further requires the Secretary, for plan years beginning on or after a date specified by the Secretary but not later than January 1, 2029, to establish in federally-facilitated Exchanges (i.e., those operated by HHS under 42 U.S.C. 18041(c)(1)) a verification process for agent- or broker-submitted enrollments and coverage changes eligible for commissions. (Thus, the process mandates consent documentation such as standardized forms; delayed commission payments until inconsistencies are resolved; issuer access to required information; timely notices to individuals on changes with cancellation instructions; consumer access to account details including agent of record via website or hotline; and agent or broker reporting of third-party marketing organizations.)