This bill amends the Affordable Care Act to strengthen enforcement against insurance fraud committed by agents and brokers who help people enroll in health plans through the federal exchange. The legislation imposes new financial penalties on agents and brokers who negligently or intentionally provide false information, ranging from $10,000 to $50,000 per affected individual for negligent violations and up to $200,000 per individual for knowing fraud, plus potential criminal penalties of up to 10 years in prison for willful violations. The bill also establishes new consumer protections, including requirements that agents obtain documented consent from individuals before enrolling them, that commissions be withheld until enrollment information is verified, and that consumers receive clear notifications of coverage changes with instructions on how to cancel unauthorized activity. Beginning no later than January 1, 2028, the federal exchange must implement verification processes for agent-assisted enrollments and establish oversight procedures including periodic audits and fraud referrals to state insurance departments. The bill applies to federal exchanges operated under the Affordable Care Act and requires agents, brokers, and marketing organizations to meet new standards of conduct, licensing requirements, and marketing restrictions.
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