Julie Appleby | (TNS) KFF Health News
A lawsuit filed on Friday outlines a scheme in which large insurance sales agency call centers enrolled or switched people into ACA plans without their permission in order to make money.
According to the lawsuit filed in U.S. District Court for the Southern District of Florida, two call centers were involved in this scheme. Tens of thousands of dollars were paid daily to obtain the names of people who responded to misleading ads about free government “subsidies” and other rewards. In return, sales agents used this information to enroll them in ACA plans or switch their existing policies without their consent.
The lawsuit alleges that as a result, consumers lost access to their doctors or medications, faced financial costs, and had to repay tax credits that were used toward the unauthorized coverage.
Some consumers were switched multiple times or ended up with duplicate policies.
The lawsuit claims that there was a plan to target low-income Americans into enrolling in health insurance through deceptive ads and unauthorized switching, to gain compensation or commissions that legitimate insurance agents would have received.
The lawyers who filed the case, Jason Doss and Jason Kellogg, are seeking class action status on behalf of several affected policyholders and agents.
KFF Health News has recently reported similar concerns expressed by consumers and insurance agents. similar concerns reported on raised by consumers and insurance agents. raised by consumers and insurance agents.
The lawsuit names TrueCoverage, Enhance Health, Speridian Technologies, and Number One Prospecting as defendants, along with Brandon Bowsky and Matthew Herman. Attempts to reach the companies for comment were unsuccessful.
The call centers had access to policyholder accounts through “enhanced direct enrollment” platforms, including one called Benefitalign, owned by Speridian.
Private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov. The platforms involved in this case were not open to the public, but only to those call center agencies granted permission by the platforms. must be approved by the Centers for Medicare & Medicaid Services
A Texas resident named Conswallo Turner signed up for ACA coverage in December through an agent she knew, but later saw an ad on Facebook promising a monthly cash card to help with household expenses. After calling the number on the ad and providing her personal information, sales agents changed her ACA coverage and the agent listed on it multiple times without her consent.
The lawsuit claims that she ended up getting a plan with a higher deductible and had to pay medical bills for her son who was now without insurance. Additionally, her agent lost their commission.
The lawsuit includes similar accounts from other people suing.
According to the lawsuit, the scheme involved gathering names of individuals who responded to online and social media advertisements offering monthly financial assistance for rent or groceries. The calls were recorded, and TrueCoverage and Enhance Health obtained the information of the callers.
The companies were aware that people were calling based on the promise of receiving cash benefits that were non-existent. Instead, call center agents were advised to be vague about the money mentioned in the ads, which in reality were the subsidies provided by the government to insurers for the ACA plans.
The lawsuit alleges that the effort targeted individuals with low enough incomes to qualify for substantial subsidies that completely covered the monthly cost of their insurance premiums. This push began after March 2022 when a special enrollment period for low-income individuals became available, allowing year-round enrollment in ACA plans.
The lawsuit asserts that the individuals involved did not comply with the privacy and security regulations required for participation in the ACA marketplace. It also alleges violations of the federal Racketeer Influenced and Corrupt Organizations Act, known as RICO.
“It’s not a victimless crime to get zero-dollar health insurance if you don’t qualify for it and it ends up causing you tax or other problems down the road,” he said. “Unfortunately, there’s so much fraud that legitimate agents who are really trying to help people are also being pushed out.
KFF Health News
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The lawsuit alleges that consumers lost access to their doctors or medications, and incurred financial costs, such as owing money for medical care or having to repay tax credits that were used for the unauthorized coverage.
