With the difficulties that individuals have already faced in trying to access, shop and enroll online in the health insurance exchanges attracting most of the roll-out attention, it's easy to forget that every new major online venture also opens consumers to the possibility of fraud.
Insurers and other healthcare organizations can help consumers understand how to protect their private health and financial information. Payers, including Blue Cross Blue Shield and Cigna, have sections in their websites dedicated to safeguarding against healthcare fraud.
The Health and Human Services Department, too, has posted a warning about scam artists using the health insurance exchanges to con individuals. "Consumers need to be able to shop for health insurance without being defrauded by criminals taking advantage of a new program," said Jennifer Trussell, special advisor in the Office of Investigations in HHS' Office of Inspector General in a podcast.
HHS, the Federal Trade Commission, and the Department of Justice are working together to prevent and prosecute consumer fraud in the new marketplaces by connecting consumers to complaint assistants, routing complaints for analysis and referral, establishing a rapid response for privacy or cybersecurity threats, and ramping up public education on how to avoid scams.
A recent white paper from Thomson Reuters found that easy access to personal consumer data, such as Social Security numbers and other personally identifying information, has led to a dramatic increase by organized crime in the number of fraud attempts related to many lines of insurance, including health.
Changes in the healthcare system will also bring in massive amounts of new funding, attracting organized crime. But the changes also offer an opportunity for healthcare organizations to build in anti-fraud and preventive elements, much like Medicare and Medicaid has done over recent years.
Industry can help educate potential customers to beware of:
People asking for money to enroll consumers in the exchange or Obamacare insurance. Legitimate enrollment assisters will not ask for money.
High-pressure visits, mail solicitations, emails and phone calls from people pretending to work for the government. No one can threaten legal action for not signing up for a plan.
People not contacted by the consumer but who request personal information may be trying to steal identities. No one from the government will call or email to sell an insurance plan or ask for personally identifying information, such as Social Security numbers or credit card information.
Sham websites. Look for official government or insurance exchange logos or website addresses.
Medicare beneficiaries do not obtain insurance in the new health insurance exchanges.
New York is among a number of states issuing consumer advisories recently to help avoid scams. Organizations, including the Coalition Against Insurance Fraud and AARP, have also cautioned about fraud.
If you think one of your customers may be a fraud victim, tell them to contact the health insurance marketplace consumer call center at 800-318-2596.