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White House Moves to Ease Insurance Fraud Fears


“This is just the latest obstacle that opponents of the Affordable Care Act are using to try to slow down implementation,” said Christine Barber, senior policy analyst with Community Catalyst, a Boston-based nonprofit helping states with enrollment.

“It’s having a chilling effect already as some organization are nervous to help with enrollment because of all the obstacles placed in their path,” she said.

At least four groups have declined federal grants as a result of state restrictions while others are rethinking their roles. A West Virginia agency returned $365,000 after it was asked extensive questions about its hiring and personnel practices by the Republican West Virginia attorney general. “There were unforeseen circumstances,” said Pat Haberbosch, executive director of West Virginia Parent Training and Information, Inc.

Children's Hospital Medical Center in Cincinnati also declined its grant because the state barred groups from serving as navigators that negotiate with health plans.  And Texas-based Cardon Outreach is turning back $800,000 to hire guides in Florida, Oklahoma, Utah and Pennsylvania because of state scrutiny, according to an Associated Press report.

Ron Pollack, executive director of Families USA, a consumer advocacy group that supports the law, called the efforts a “conspiracy” designed “to keep down the numbers of people who get enrolled.”

Why Navigators Matter

Navigators are considered crucial to the success of Obamacare because they are supposed to help consumers sort through a maze of insurance options and figure out whether they’re eligible for federal subsidies or perhaps free or low-cost coverage through Medicaid.  Polls show many people know very little about these options.

Most of the states restricting their roles, including Oklahoma, Ohio and Indiana, have defaulted to the federal government to run their exchange websites and are doing no education or marketing about new coverage options.

Obama administration officials  sought Wednesday to reassure consumers that navigators will not be collecting medical records or asking detailed questions about their health because beginning Jan. 1, that will have no bearing on whether they can get coverage or how much they will pay.

The new anti-fraud initiatives include letting people report suspected scams through the marketplace’s call center and to the Federal Trade Commission through the website.

The federal government is also setting up a “rapid response” system to deal with any security breaches and putting together tip sheets to advise consumers about how to protect themselves.

Impact Of State Restrictions

Experts say it’s premature to say how big an impact the state restrictions on navigators might have -- or how aggressively the laws will be enforced. Missouri passed a law that requires navigators to pass an exam and pay a licensing fee. But state regulators have since said that the 20 hours of required federal training will be accepted in lieu of state training and an exam, and have also limited the licensing fee to $25.

Wed, Sep 18 2013

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