Scamming People with Phony ACA Healthcare Insurance Plans

I am not surprised scamming like this is occurring. There are always people operating under false names or using corporate entities as a way to scam others. I think trump helped to open the door for much more of this to happen.

Here are six different ways scamming has been happening. No funds passed . . . no contract.

Fraudsters selling homeless people ACA plans they can’t afford, WUSF

Forty-year-old Zhelyazkova was living at a homeless shelter and needed Suboxone, a medication to manage the symptoms of opioid withdrawal. At the end of 2021, a stranger approached her on the street and offered her $5 to sign up for a “free” health insurance plan with Florida Blue. The person instructed her to use a false address and falsify her income so she could be seen as eligible for coverage, she said.

When the plan took effect the following year, Zhelyazkova learned the downsides.

Signing up for private insurance disqualified her from Ryan White coverage. Florida Blue’s provider network did not include the hospital pharmacy. She would need to go to a Walgreens and lacked transportation. She was also in need to come up with a $20 copay, which she could not afford.

A nonprofit needle exchange program finally paid for the drug.

Social media hoax promises cash allowance for health care, PolitiFact

Two videos posted on Facebook garnered hundreds of thousands of views for claiming that Americans could sign up for free awards to cover health care costs. The first video shows a graphic of a credit card under someone adding groceries to a cart. A robotic-sounding voiceover said Americans who make less than $50,000 could sign up for a health credit card that would cover not only health and medical bills, but could also be used to buy “gas, groceries and other things they need to pay for.”

The other Facebook video claimed that registration was open for people to sign up for a $5,200 health allowance. 

Referring to President Joe Biden, the voice in the video said:

“I can’t believe what the prez announced. The newest incentive for anyone who doesn’t have Medicare or Medicaid. I got $5,200 worth of health allowances for my wife and I. It’s so nice being able to get my prescriptions and going to the doctor for free. Just click below and you can get qualified, too.”

PolitiFact rates the Facebook posts’ claim False. I rate it as a lie and fraud.

New rule to stop insurance brokers from fraudulently enrolling people in plans, Health News, NPR

Some insurance brokers are enrolling people into Affordable Care Act health plans without their consent. A move putting consumers in danger of owing back the subsidies connected with the coverage. The damage could be hundreds or even thousands of dollars.

A consumer’s first hint that something is wrong is a big one. It comes in a letter from the IRS or a delay in their tax refund.

Although the practice does not appear widespread, it has prompted the Department of Health and Human Services to seek changes to some oversight rules affecting brokers. They would start in 2023.

HHS wants the changes, according to its proposal, because it “has observed several instances in which agents, brokers, and web-brokers have provided inaccurate consumer household income projections” and that “this is problematic in situations when consumers are enrolled without their knowledge or consent.”

U.S. judge finds Aetna deceived the public about its reasons for quitting Obamacare, Los Angeles Times.

 A federal judge has ruled Aetna claiming it was simply losing too much money on the Obamacare exchanges was a rank falsehood. Judge John D. Bates said Aetna made its decision at least partially in response to a federal antitrust lawsuit blocking its proposed $34-billion merger with Humana.

Aetna threatened federal officials with the pullout before the lawsuit was filed, and followed through on its threat once it was filed. Bates made the observations in the course of a ruling he issued Monday blocking the merger.

While Buying Health Insurance for Emergencies, He fell into a $33,601 Trap, ProPublica

In the spring of 2019, Cory Dowd suddenly found himself without health insurance. A self-employed event planner, he had just finished a Peace Corps stint that provided health benefits. He was still more than a year away from starting a graduate program that would provide coverage through his university.

Like countless others in an online world, he went insurance shopping on the internet. The individual insurance market he was entered was one dramatically changed under President Donald Trump’s push to dismantle Obamacare. It was offering more choices at cheaper prices.

Even he did not understand the extent to which insurers could offer plans looking like a great deal. The fine print allowed companies to deny payment for routine medical events.

Not bound by the strict coverage rules of the Affordable Care Act, the short-term plans that Dowd signed up for have been dubbed “junk insurance” by consumer advocates and health policy experts. The plans can deny coverage for people with preexisting conditions, exclude payments for common treatments, and impose limits on how much is paid for care.

He only saw a great deal. Six months of coverage offered through an agency called Pivot Health. Their website touts the company as a “fast-growing team obsessing with helping you find the right insurance for your needs.”

The monthly premiums for the two short-term plans were surprisingly cheap at around $100 a month each. Each had reasonable co-pays for routine doctor visits and treatments. The first plan promised to cover up to $1 million in claims and the second up to $750,000. Both plans were more than enough. Dowd was 31 and healthy. He signed up and began paying his premiums without reading the details.

Dowd was hit with the very kind of emergency he feared. He found he was not covered after all.

Under the Obama administration short-term plans were limited to three months. The Trump administration allowed them to be extended to nearly a year. They became a fast-growing and lucrative slice of the insurance industry.

These plans are not legally bound by the strict rules of the ACA. Not only do the plans come with restrictions and coverage limitations, but insurers can search through patients’ past medical histories to find pre-existing conditions.

The hospital’s billing office urged Dowd to file an insurance appeal. He dug into his policy paperwork. As he read through a long list of exclusions and disclaimers, he found one addressing surgical services. It Iimits coverage to “usual and customary charges and not to exceed $2,500 per surgery.”

In a mix of fury and frustration, he thought. “I do have to wonder exactly what kind of surgical procedure can be had for $2,500.”

When told of Dowd’s experience, Jeff Smedsrud, Pivot’s CEO, said he was surprised and advised Dowd to appeal directly to Pivot. The pirate criticized the hospital for billing Dowd what insurance did not pay.

All companies selling short-term plans have to do is acknowledge that they are not ACA compliant and may not cover everything.

ACA health insurance plans are being switched without enrollees ok, Health News, NPR

Some consumers covered by Affordable Care Act insurance plans are being switched from one plan to another without their knowing such and without permission. This could leave them unable to see doctors or fill prescriptions. Some are also facing large IRS bills for back taxes.

Unauthorized enrollment or plan-switching is a serious challenge for the ACA. Brokers say the ease with which rogue agents can get into policyholder accounts in the 32 states served by the federal marketplace plays a major role in the problem.

Indeed, armed with a person’s name, date of birth, and state, a licensed agent can access a policyholder’s coverage through the federal exchange or its direct enrollment platforms. It is harder to do through state ACA markets, because they often require additional information.

Unwittingly Michael Debriae a restaurant server who lives in Charlotte, North Carolina was one victim. He ended up in plans he did not choose and ended up with a large tax burden.

The tax burden happens when enrollees are signed up for coverage that includes premium tax credits paid by the government to insurers. This occurs even though the enrollee is ineligible due to a misstated income by a broker making the switch, or they had job-based insurance.

Unbeknownst to him, an agent in Florida with whom he had never spoken enrolled him in an ACA plan in March 2023. It was two months after he canceled his Obamacare coverage because he was able to get health insurance through his job. In June, he discovered he had a new ACA policy when his longtime pharmacy said it could not fill a 90-day prescription, which it had done with no problem in the past.

“That’s when I realized something horribly wrong had happened,” says Debriae.