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Thu. Jul 18th, 2024

Wyden demands fines for Obamacare enrollment fraud

By Vaseline May30,2024

Good morning. I’m Julie Appleby, senior correspondent for KFF Health News, and I write about all things insurance. Send tips to [email protected]. The Health Brief copies Congress and takes Friday off. We will be back in your mailbox on Monday morning.

Today’s edition: An industry group representing clinical laboratories across the country is suing the Food and Drug Administration about his plans to regulate certain medical tests. A super PAC trying to help Democrats regain control of the House of Representatives is making a historic push for abortion rights. But first …

A powerful lawmaker says CMS should already punish unscrupulous Obamacare brokers

Lawmakers and state officials are mounting pressure on federal regulators to prevent unscrupulous, commission-hungry insurance agents from enrolling thousands of people in Affordable Care Act plans, or changing their coverage, without their knowledge.

Customers often only discover the changes when their medical coverage is denied or they get stuck with a bill for ACA tax credits that they have to pay back.

Chairman of the Senate Finance Committee Ron Wyden (D-Ore.) said he will propose legislation to address the Centers for Medicare and Medicaid Services to hold fraudulent brokers “criminally responsible” for their actions. The agency, which oversees the ACA exchanges, can fine individuals up to $250,000 for submitting false information on a health plan application, but that did not happen, Wyden said.

“I am disappointed that these penalties have not yet been used to hold bad actors accountable,” Wyden wrote in a strongly worded letter to the CMS chief last week. Chiquita Brooks-LaSure.

Jimmy Patronis, who as Florida’s chief financial officer oversees agencies including insurance regulators, called on Congress to push CMS to require two-factor authentication on healthcare.gov and related platforms that agents use to sign people up for coverage. According to Patronis, the state has more than opened 900 investigations to problem registrations.

“It is much easier to prevent fraud in the first place than to ask government regulators to catch these bad actors after the fact,” Patronis wrote.

The problem seems concentrated among the 32 states through the federal marketplace healthcare.gov, because brokers say it’s too easy for rogue agents to access policyholder information. All they need is a name, date of birth and state.

States that manage their own insurance markets typically impose additional security requirements.

CMS was right 90,000 complaints about unauthorized registrations or switching plans in the first quarter of 2024, on more than 16 million registrations.

Jeff Wuacting director of the Center for Consumer Information and Insurance Supervision at CMS has said its agency is preparing regulatory and technology solutions, investigating brokers and working to bring consumers back to their chosen plans.

But even with Wyden’s legislation underway, it seems unlikely that Congress will take action. Lawmakers are in the midst of an election year in which President Biden seeks to win votes to increase enrollment in ACA plans while toppling his opponent, the former president Donald Trumpfor his failed attempt to repeal the law.

Sabrina Corlette, who follows the ACA market as co-director of the Center for Health Insurance Reform bee Georgetown Universitysaid the FBI can do more, including better coordination with state investigations.

But states like Florida should also regulate marketplaces, she said.

“If there are a lot of bad real estate agents in Florida, then Florida needs to look inward and maybe do a better job of supervising real estate agents,” she said.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of its core operating programs KFF – an independent source of health policy research, opinion polls and journalism.

Trade group sues FDA over lab testing regulations

An industry trade group is suing to block the FDA from regulating laboratory tests (LDTs), a divisive plan that the agency finalized last month over concerns about its reliability and risks to patients.

The lawsuit, which was filed yesterday by the American Clinical Laboratory Association and one of its affiliates claims the final rule exceeds the agency’s authority. The group argues that LDTs ​​are “professional health care services,” not devices, and should not be regulated in a similar manner.

  • The complaint urges a federal court in Texas to rule that the FDA cannot legally regulate LDTs ​​under the Federal Food, Drug and Cosmetic Act and seek an order to vacate the policy.
  • A spokesperson for the FDA said the agency does not comment on pending litigation.

In other news from the agencies…

  • The FDA and independent researchers are to alarm about nicotine alternatives in vapingnoting that these synthetic substances may be more potent and addictive than traditional nicotine but can be sold without federal authorization, Emma Rumney reports for Reuters.
  • The federal Department of Health’s Inspector General has found widespread problems with Medicare’s oversight of payments for orthotic braceswhich consistently have among the highest improper repayment rates, according to a new report from the government watchdog.

The House Democratic PAC promotes abortion rights

A super PAC trying to help Democrats regain control of the House of Representatives is launching a $100 million campaign that will target abortion rights in swing districts across the country, The Post Amy B Wang reports.

The House Majority PAC is new Reproductive Freedom Accountability Fund will be the “largest independent expenditures on behalf of Democrats in the House of Representatives,” according to a memo to donors. The group plans to spend the money on advertising and voter mobilization in races where it sees an opportunity for Democratic candidates to gain a seat if they focus on reproductive rights.

A closer look: The memo identified Republican lawmakers in blue states who voted against abortion rights as particularly vulnerable, with California representatives checking their names. David G. Valadao, Mike Garcia And Michelle Steelwho co-sponsored a bill that defined life as beginning at conception.

  • The PACT also called out Republican lawmakers New YorkCalifornia, Washington and New Jersey who had voted to restrict medication abortion, or who supported banning reimbursement for abortion services to military service members.

The interest group Americans for contraception is launching a new advertising campaign highlighting Republican opposition to expanded access to birth control ahead of a Senate vote on legislation to create a federal right to contraception, according to the hill‘S Nathaniel Weixel.

The first wave of the campaign includes two ads running in the DC market until the expected Senate vote on the Right to Contraception Act, tentatively scheduled for next week. After the voting is over $5 million in ads will follow nationwide in battleground states.

  • Today on tap: Government officials and senior executives from across the medical industry will meet in Maryland Council for Professional Services‘s annual FedHealth conference to discuss policy and acquisition priorities in civilian and military healthcare.
  • Sens. Bernie Sanders (I-Vt.) and Wyden are investigating the data analysis company Multiplan over concerns that the out-of-network payment rates it negotiates on behalf of insurers are saddling patients with “skyrocketing medical bills.”
  • The Association for Pharmaceutical Care Management is launching a national advertising campaign highlighting the role of pharmacy benefit managers. This comes amid a bipartisan investigation on Capitol Hill, where lawmakers allege prescription drug middlemen are driving up drug prices.

Washington prepares for Trump’s term that could lead to cuts to health programs (by Victoria Knight and Peter Sullivan | Politico)

House Republicans’ new 340B bill ‘a wish list for the pharmaceutical industry,’ hospitals say (by Dave Muoio | Fierce Healthcare)

AI brain map could help demystify Alzheimer’s and autism (by Richard Luscombe | The Guardian)

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