Fraudulent Agent Reporting
If you or your client suspect a third-party agent has fraudulently claimed your client’s application as their own and you have documented consent from your client, please encourage your client to report the suspected fraud to the plan issuer and to their state department of insurance. In addition, follow the guidance below to inform CMS and the NAIC (National Association of Insurance Commissioners):
For Agents:
1. If you as an agent are aware of others conducting a search for consumer applications using DE/EDE websites, enrolling consumers, making unauthorized changes to consumer applications without their explicit consent, or inappropriately accessing CMS systems, report it to the Agent/Broker email help desk at FFMProducer-AssisterHelpDesk@cms.hhs.gov. Make sure to include FFM application ID and Agents NPNs for reference. Avoid including Personally Identifiable Information. Ex: name, social security number, address, email address, and date of birth. Also attach a copy of your consent documentation for the respective client.
2. Report to NAIC (National Association of Insurance Commissioners) here, as well as the state Department of Insurance for your state. For Texas, report here or call (800)-252-3439.
3. If enrolled through HealthSherpa, report directly to the HealthSherpa Fraud Prevention Unit by emailing fraud_prevention@healthsherpa.com or calling (855)-977-525. HealthSherpa will check their records and if fraud is found they will block the agent from accessing their systems.
4. Encourage your client to call the Marketplace Call Center and the Department of Insurance to report the issue. As a client, it is the most effective way to report the issue. The number for the Marketplace is 1-(800)-318-2596. The number for Texas’s DOI is (800)-252-3439.
For a list of all State Department of Insurance phone numbers, click here. Once there, scroll down till you see “file a complaint” and then select the state in which you are wanting to contact.
Again, make sure to keep compliance throughout the entire process, be diligent, and provide correct information while reporting. You can view the do’s and don’ts here.
On the following pages, you will find our email & call script templates as well as the plan issuers by carrier contact info to help you and your client report these issues.