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White House Moves to Ease Insurance Fraud Fears

WebMD News from Kaiser Health News

By Phil Galewitz

Wed, Sep 18 2013

The White House on Wednesday unveiled several steps to protect consumers from fraud in the new online health insurance marketplaces, a move that comes after 17 states hostile to the law acted to limit the spread of information about the program, and congressional Republicans raised concerns about the privacy of medical and financial records.

"We are sending a clear message that we will not tolerate anyone seeking to defraud consumers in the health insurance marketplace," said Health and Human Services Secretary Kathleen Sebelius.

Senior administration officials acknowledged the potential for scams with any new government program, including the Obamacare marketplaces that open for enrollment Oct. 1 and are expected to help 7 million Americans get coverage next year.

But they stressed that the health law's new "navigators" -- federally-paid groups that help people enroll in coverage -- do not represent a significant risk and that Medicare has used such guides for years without problems or controversy.

The announcement was unlikely to appease the law's opponents, however -- among them, Oklahoma’s top insurance regulator, John Doak, who has already put navigator groups on notice.

On the same day that officials at Little Dixie Community Action Agency in Hugo, Okla., won a $580,000 federal grant to help consumers sign up for coverage under the federal health law, Doak issued a warning. If the consumer guides perform any of the duties of state-licensed insurance agents, he said, "we will put a stop to it." He also called the $1.6 million award to hire and train the guides in Oklahoma -- part of $67 million nationwide -- "a waste" because it would duplicate the work of better-trained agents. 

At Least 17 States Limit Navigators

Oklahoma is among at least 17 Republican-controlled states that have taken steps to restrict the 105 groups that won the federal grants, including churches, colleges, social service agencies and Planned Parenthood. Some states such as Indiana are requiring navigators to pay as much as $175 for licensing that would include a state exam and a criminal background check.

Others, such as Missouri and Georgia, have passed laws limiting what navigators can say and do. Last week, the Florida Health Department announced that local public health offices, where uninsured people often go for services, cannot have navigators on the premises.

State officials say they’re concerned the navigators, who are required by the federal government to get 20 hours of online training and pass an exam, will know too little to be helpful. They also worry about their access to private information, such as Social Security numbers.

But the law’s proponents see the restrictions as simply the latest GOP effort to impede the rollout of the law known as Obamacare, and worry they will dampen enrollment.  

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