Amends the Patient Protection and Affordable Care Act to address fraudulent enrollments in qualified health plans.
Introduces civil penalties for agents and brokers who fail to provide correct information, with fines ranging from $10,000 to $50,000 per individual affected.
Establishes higher penalties for agents and brokers who knowingly provide false information, with fines up to $200,000 per individual.
Introduces criminal penalties for agents and brokers who willfully provide false information, including fines and imprisonment for up to 10 years.
Mandates a verification process for agent- or broker-assisted enrollments in qualified health plans, effective by January 1, 2028.
Requires agents and brokers to provide documentation proving consent from individuals for enrollments or coverage changes.
Stipulates that commissions for agents and brokers are paid only after inconsistencies in enrollment are resolved.
Ensures individuals are notified of any changes to their enrollment or coverage in a timely manner.
Requires agents and brokers to report any third-party marketing organizations involved in the enrollment process.
Establishes criteria for regulating agents, brokers, and marketing organizations, ensuring they act in the best interests of enrollees.
Implements periodic audits of agents and brokers to ensure compliance with regulations and to detect potential fraud.
Develops a process for sharing audit results and referring potential fraud cases to state insurance departments.
Creates a system for providing qualified health plans and states with a list of suspended and terminated agents and brokers.
