Switcheroo Scams: Stopping Unauthorized Health Plan Switching

Complications: Health Policy Unraveled

Recently, some consumers have found that their health plans had been changed without their knowledge, impacting their coverage and their finances.

In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan explores unauthorized plan switching related to Affordable Care Act health plans. Consumers are being unknowingly switched to different health plans, resulting in coverage disruptions, financial losses, and even loss of access to care. Misleading ads and unethical practices by some call centers combined with changes in enrollment periods are exacerbating the issue, leading to lawsuits and regulatory concerns. Despite efforts by federal and state regulators, challenges remain in detecting and addressing these unauthorized switches effectively. Tune in to learn more about the latest scam targeting low income individuals seeking medical coverage.

Meet Your Host

Name: Stephanie Kennan

Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting

Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.

Connect: LinkedIn

Episode Highlights

[0:40] A recent Kaiser Family Foundation report identified incidents in which consumers learned that their health plans had unknowingly been changed, affecting their health coverage and finances.

[1:12] A lawsuit has been filed in the Southern District of Florida against call centers who allegedly paid for individuals’ information and then switched their health insurance policies without their knowledge, resulting in additional costs or coverage issues for consumers.

[2:44] It appears this scam began as a way to target those seeking coverage during a special enrollment period for low income individuals.

[3:16] It is currently unknown how many complaints have been filed with CMS, but the issue has certainly ramped up in the last year and is mostly concentrated on the federal healthcare.gov website.

[4:08] Enrollment has been a top priority for the health insurance marketplace, so finding a way to stop bad actors while still encouraging new consumers presents a challenge.

[4:28] The complaint process, which would initiate an investigation, is cumbersome, not centralized between state and federal agencies, and confusing for many.

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