Federal Agencies Create Initiative to Prevent Potential Fraud in the Health Insurance Marketplace.

On September 18, representatives from the Department of Justice (DOJ), the Department of Health and Human Services, the Federal Trade Commission (FTC), and state partners met at the White House to discuss initiatives to prevent, protect, and prosecute consumer fraud and privacy violations in the Health Insurance Marketplace.  The interagency officials noted the following new initiatives:

• A Marketplace call center with trained staff refers consumer threats, complaints and fraud concerns to FTC’s Consumer Sentinel Network.   
• Use HealthCare.gov to connect consumers to FTC’s complaint assistant.
• Create a system to route complaints through the FTC’s Consumer Sentinel Network for analysis and referral as needed.
• Develop a rapid response system for addressing privacy and cybersecurity threats.
• Improve public education of consumers and assisters to avoid scams.

Federal law enforcement officials will have the ability to monitor complaint activity for trends within all 50 states.  Consumer fraud experts from state and federal agencies plan to meet on a regular basis to monitor potential fraud in the Health Insurance Marketplace.

Further information on fraud prevention efforts in the Marketplace is available at:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-09-18.html.

The DOJ news related to marketplace fraud initiatives is available at:

http://www.justice.gov/opa/pr/2013/September/13-ag-1038.html.

About the Author

Ms. Shuman assists health care organizations to develop, implement and evaluate their compliance programs and HIPAA privacy programs. Ms. Shuman specializes in our firm’s HIPAA Privacy services, including leading privacy investigations, breach risk assessments, breach notification letters, breach reporting to the Office for Civil Rights and corrective actions plans. She specializes in serving as Interim Privacy Officer for large health care systems, managed care organizations, comprehensive cancer center and health care business associate.