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Fraud Fear Raised in California’s Health Exchange

As California prepares to launch its healthcare exchange known as Covered California, officials are concerned that new rules could put consumers at risk of fraud...
July 16, 2013

As California prepares to launch its healthcare exchange known as Covered California, officials are concerned that new rules could put consumers at risk of fraud. The exchange recently adopted rules for a network of more than 21,000 enrollment counselors as part of the federal Affordable Care Act (ACA), who in some cases will have access to consumers’ personal, medical and financial information. California Insurance Commissioner Dave Jones warns that the exchange is not doing enough to ensure that the people hired as counselors are sufficiently screened and monitored, and that the exchange lacks a plan for investigating any complaints. “We can have a real disaster on our hands,” Jones says.

Jones said that it’s not enough to adopt policies and procedures against fraud. Instead, he said the exchange needs a more comprehensive plan to follow up on complaints and work with law enforcement officials to prosecute bad counselors. Without it, the exchange will risk consumer confidence because the enrollment counselors are “being given a good housekeeping seal of approval” by the state, he says.

“Once they’re in that position of trust, it’s possible they will obtain information that will allow them to build the trust they have with the individual they’re working with and potentially sell them all manner of bogus products, steal their identity, gain access to certain assets they might have,” Jones said. “The list is virtually endless.” Eric von Geldern, a deputy district attorney in Alameda County, said the exchange has adopted some good policies but can do more to protect consumers.

Fear of Fraud in California’s Health Exchange (Associated Press 7/14/13)

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