Insurance Fraud Accountability Act

This bill aims to stop fake or unauthorized sign-ups in Affordable Care Act (ACA) health plans. It raises penalties for insurance agents and brokers who submit false or careless information, and it builds new safeguards so people can’t be switched or dropped without their clear consent. It also brings more oversight to marketing companies that help with enrollments.

Key points

• Who is affected: People buying ACA plans; insurance agents and brokers; marketing firms that generate leads or help enroll people.
• What changes:
  • Tougher penalties: Agents/brokers who are negligent face $10,000–$50,000 per affected person; those who knowingly submit fake info face up to $200,000 per person and could get up to 10 years in prison.
  • Proof of consent: For enrollments and plan changes done through the federal marketplace, agents must keep proof you agreed (like a standard consent form). You must get timely notice of any changes and clear steps to fix anything you didn’t authorize. You can see your account and agent-of-record info online or by toll-free phone. Broker commissions are held until your paperwork issues are resolved, and plans can access a database to confirm this. Agents must also report any marketing firms involved.
  • Keep coverage: The government cannot disenroll you without your consent, to protect your care and coverage.
  • Marketing oversight: States will apply standards for agents, brokers, and marketing firms, including a duty to act in your best interests, licensing/registration, honest marketing (no confusing or misleading practices), submitting materials for review, and reporting when agents are terminated.
  • Audits and transparency: Regular audits based on complaints or suspicious patterns; results shared with states; and a shared list of suspended or terminated agents/brokers for plans, Exchanges, and states.
• When: These steps must begin on a date set by federal health officials, but no later than January 1, 2029.