Whether you call it the Affordable Care Act or Obamacare, healthcare reform is fast approaching. Open enrollment for the exchanges starts just a mere four months away in October, and coverage takes effect in January 2014.
These exchanges will bear the brunt of insuring many small businesses, families and individuals — some of whom aren’t now insured. States are creating their own exchanges, but the feds will create and run some exchanges if the host state begs off. We can also expect state-federal partnership exchanges, and regional ones.
The Coalition has noted several developments that raise concerns for anti-fraud efforts with the exchanges. Our main concern: How will anti-fraud efforts be managed amid this mishmash of diverse exchanges?
In discussions with state insurance regulators and health insurers, we expect that health insurers now supplying coverage in states also will be included in the exchanges. Yet it’s unclear if their anti-fraud efforts will remain the same once inside an exchange. We also need to determine what anti-fraud plans and other requirements exchanges will expect from insurers.
But more than anything, the Coalition will closely monitor how the states and exchanges protect consumers and small businesses from being solicited by shady operators who mask their scams under the aegis of a health exchange.
One possible scheme: Fake exchange recruiters with forged credentials go door to door, trying to steal consumers’ sensitive financial data under the guise of signing them up for an exchange.
Concern about schemes is widespread enough that they’ve caught the attention of key federal watchdog agencies.
CMS, the Senate Aging Committee and Federal Trade Commission already have sought the Coalition’s expertise. The Coalition has met with these agencies to share field intelligence and strategic insights about current and potential “Obamacare” schemes.
Suspicious websites lying that they’re exchanges already have sprung up. Several states have shut them down. But how many others are waiting to lure consumers and small businesses into thinking they’re buying real insurance from a legitimate exchange?
Exchanges can be focal points for educating consumers and small businesses about scams that may strike in the coming months. Public-interest groups such as the Coalition are interviewing reporters and sending consumer alerts around the U.S.
Equally important, Washington and state capitals should use their outreach resources and influence to help develop an alert consumer population that will simply close the door or hang up the phone when shysters come calling.
About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.