HR2079-119

What This Bill Does

The Insurance Fraud Accountability Act responds to fraudulent or unauthorized enrollment in qualified health plans sold through ACA Exchanges. It separates agent and broker misconduct from ordinary applicant errors. Agents or brokers who negligently provide incorrect information face civil penalties of $10,000 to $50,000 per affected individual. Agents or brokers who knowingly provide false or fraudulent information face civil penalties up to $200,000 per affected individual, and knowing and willful false information can be punished under title 18 by a fine, up to 10 years in prison, or both. For federally operated Exchanges, HHS must establish, by no later than January 1, 2029, a verification process for broker-submitted new enrollments and coverage changes, including consent documentation, delayed commissions until inconsistencies are resolved, qualified health plan access to verification data, consumer notices of changes to enrollment, coverage, agent of record, or premium tax credits, and account-access protections. The bill also requires enhanced direct-enrollment platforms to display plan information without misleading rankings, sets marketing and registration duties for agents, brokers, field marketing organizations, and third-party marketing organizations, requires reports of terminations, mandates audit processes coordinated with states and NAIC, and creates regular lists of suspended and terminated agents and brokers.

Who Benefits and How

ACA marketplace consumers benefit from consent verification, notices of unauthorized changes, and stronger penalties for fraudulent enrollments. Qualified health plans benefit from access to verification data and lists of suspended or terminated agents and brokers. State insurance departments benefit from federal audit referrals and termination reports tied to Exchange fraud. Compliant agents benefit if higher penalties and marketing rules reduce unfair competition from fraudulent brokers.

Who Bears the Burden and How

ACA agents and brokers face higher civil penalties, criminal exposure, consent documentation, marketing rules, registration, and audit risk. Field marketing organizations must meet federal marketing, licensing, registration, referral-compensation, and termination-reporting rules. CMS must build verification, notice, audit, database, referral, and suspended-agent list processes for federally operated Exchanges. Enhanced direct-enrollment platforms must change plan displays, ranking practices, account access, and consumer protections.

Key Provisions

• Creates $10,000 to $50,000 civil penalties per affected individual for negligent agent or broker incorrect information.
• Creates civil penalties up to $200,000 per affected individual for knowing false or fraudulent agent or broker information.
• Provides criminal penalties of fines or up to 10 years in prison for knowing and willful false information.
• Requires federally operated Exchange verification of broker-submitted enrollments and coverage changes by January 1, 2029.
• Directs audits, state fraud referrals, marketing organization rules, termination reports, and suspended-agent lists.