Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 17, 2014

Program Area: Small Business Health Options Program (SHOP)

Question: Can Federally-Facilitated Small Business Health Options Program (FF-SHOP) issuers initiate a termination when an enrollee performs an act, practice or omission that constitutes fraud?

Answer: No, the FF-SHOP cannot accept incoming termination transactions from FF-SHOP issuers. If issuers discover what may constitute a fraudulent act, issuers should contact the SHOP Call Center to report the alleged incident so the Centers for Medicare and Medicaid Services (CMS) may investigate further.

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