Protecting Consumers Against Fraud in the Health Insurance Marketplace

By Kathleen Sebelius, Secretary of Health and Human Services
Posted September 20, 2013

As we observe Healthcare Fraud Prevention and Awareness Month in September – and beyond – let this be crystal clear to everyone: Consumer fraud has no place in the Health Insurance Marketplace, which opens for enrollment in October.

On September 18, I, along with Attorney General Eric Holder, Federal Trade Commission (FTC) Chairwoman Edith Ramirez, and key state partners met at the White House to kick off a comprehensive interagency initiative to prevent, protect against, and, where necessary, prosecute consumer fraud and privacy violations in the Health Insurance Marketplace.

We and our experienced colleagues are ready to anticipate and respond to the law enforcement challenges that may arise with the launch of the Marketplace, so that consumers can confidently and securely shop for affordable health coverage when the six-month open enrollment begins in October.

Among the initiatives highlighted were:

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  • Allowing individuals to report fraud through the Marketplace Call Center (1-800-318-2596, TTY 1-855-889-4325), which will have operators trained to take a fraud complaint and refer it to FTC’s Consumer Sentinel Network.
  • Providing easy access through to connect consumers to FTC’s Complaint Assistant for further action.
  • Routing complaints through FTC’s Consumer Sentinel Network to ensure federal, state, and local law enforcement have access to consumer complaints and can analyze and refer those complaints as appropriate.
  • Protecting personal data by ensuring that the Marketplace’s data hub is in compliance with the stringent security, privacy, and data flow standards developed by the National Institute of Standards and Technology—the gold standard for information and independent security controls assessment.
  • Empowering consumers with new educational materials about protecting themselves against fraud.

These comprehensive prevention and detection efforts build on the extensive experience and strong track record of the Obama Administration, and the state and local intergovernmental infrastructure that has long protected consumers from fraud. We are bringing the federal government’s extensive experience to bear against anyone who tries to prey on Americans signing up for health coverage in the new Marketplace.

Potential fraudsters, keep this in mind:

  • Since its creation in 1997, the HHS Senior Medicare Patrol has educated more than 28 million Medicare beneficiaries and counseled more than 1.3 million individuals about specific concerns. Coupled with other outreach efforts, Medicare’s toll-free customer service operations sent nearly 45,000 inquiries to law enforcement partners for fraud investigations in 2012 alone.
  • Over the last four years, the Justice Department has successfully prosecuted more than 4,000 defendants in identity theft and aggravated identity theft cases, and convicted over 200 defendants in advance fee fraud cases, over 500 defendants in consumer fraud cases, and over 100 defendants in telemarketing fraud cases.
  • In the last several years, the FTC’s Bureau of Consumer Protection has put a stop to more than 50 health fraud scams, government grant schemes, and mortgage relief services frauds, and has independently secured nearly $6 million in monetary relief for consumers.

Fraud image 2But while we’re doing all we can through technology and law enforcement, your best protection against fraud is you! As you apply for health coverage through the Marketplace, there are a few simple things that can help protect you from fraud.

  • Protect your personal health information. Don’t give it to anyone.
  • Protect your personal financial information. Do not give out your credit card or banking account information.
  • Know that Navigators and certified application counselors should not ask you for money to enroll in a health plan in the Marketplace.
  • Write down and keep a record of a salesperson’s name or anyone who may assist you, who he or she works for, telephone number, address, email address, and website.
  • Don’t sign anything you don’t fully understand.
  • Report anything suspicious. Call the Marketplace consumer call center at 1-800-318-2596. TTY users should call 1-855-889-4325.