Bill > S976

This bill amends the Patient Protection and Affordable Care Act to reduce fraudulent enrollments in health insurance plans by implementing stricter regulations and penalties for agents, brokers, and marketing organizations involved in health insurance exchanges. The bill establishes new civil and criminal penalties for agents and brokers who provide incorrect, false, or fraudulent information during enrollment, with fines ranging from $10,000 to $200,000 per individual application and potential criminal imprisonment of up to 10 years. It introduces a comprehensive verification process for new enrollments and coverage changes, requiring agents to obtain explicit consent from individuals, delay commission payments until enrollment inconsistencies are resolved, and report involvement of third-party marketing organizations. The bill also mandates that the Secretary of Health and Human Services create criteria for agents, brokers, and marketing organizations to participate in health plan enrollments, including requirements to act in the best interests of enrollees, meet marketing standards, and avoid misleading practices. Additionally, the bill establishes an audit process to oversee agent and broker compliance, with periodic reviews based on complaints, suspicious enrollment patterns, and other factors, and requires the development of a regularly updated list of suspended and terminated agents and brokers to be shared with health plans, exchanges, and states.

Health and Social Services

https://www.congress.gov/bill/119th-congress/senate-bill/976/all-info