Health, Education, Labor, and Pensions Committee, Homeland Security and Governmental Affairs Committee, Permanent Subcommittee on Investigations
Introduced
In Committee
On Floor
Passed Chamber
Enacted
This bill, the "Insurance Fraud Accountability Act," aims to strengthen the integrity of the Patient Protection and Affordable Care Act by reducing fraudulent enrollments in qualified health plans. It achieves this by imposing stricter penalties on agents and brokers, enhancing consumer protections, and increasing regulatory oversight of the enrollment process to prevent deceptive practices. The bill significantly increases penalties for agents and brokers involved in providing incorrect or false information during enrollment. Agents or brokers who negligently provide incorrect information face civil penalties ranging from $10,000 to $50,000 per individual, while knowingly providing false information incurs civil penalties up to $200,000 per individual and potential criminal charges including imprisonment. To protect consumers, the bill mandates a verification process for agent or broker-assisted enrollments in federally-operated Exchanges. This includes requiring individual consent, delaying commission payments until enrollment inconsistencies are resolved, and ensuring timely notifications of enrollment changes with instructions to cancel unauthorized activity. It also guarantees individuals can access their account information and prioritizes continuity of coverage. The legislation also grants the Secretary authority to regulate field marketing organizations and third-party marketing organizations involved in the enrollment chain. These entities must adhere to a standard of conduct , including acting in the enrollee's best interest, and comply with strict marketing requirements, such as submitting materials for review and avoiding misleading practices. Additionally, the bill establishes a transparency framework through periodic audits of agents and brokers, sharing results with States, and maintaining a public list of suspended and terminated agents.
Accounting and auditingAdministrative law and regulatory proceduresCivil actions and liabilityConsumer affairsCriminal procedure and sentencingDepartment of Health and Human ServicesFraud offenses and financial crimesGovernment information and archivesHealth care costs and insuranceMarketing and advertising
Insurance Fraud Accountability Act
USA119th CongressS-976| Senate
| Updated: 11/6/2025
This bill, the "Insurance Fraud Accountability Act," aims to strengthen the integrity of the Patient Protection and Affordable Care Act by reducing fraudulent enrollments in qualified health plans. It achieves this by imposing stricter penalties on agents and brokers, enhancing consumer protections, and increasing regulatory oversight of the enrollment process to prevent deceptive practices. The bill significantly increases penalties for agents and brokers involved in providing incorrect or false information during enrollment. Agents or brokers who negligently provide incorrect information face civil penalties ranging from $10,000 to $50,000 per individual, while knowingly providing false information incurs civil penalties up to $200,000 per individual and potential criminal charges including imprisonment. To protect consumers, the bill mandates a verification process for agent or broker-assisted enrollments in federally-operated Exchanges. This includes requiring individual consent, delaying commission payments until enrollment inconsistencies are resolved, and ensuring timely notifications of enrollment changes with instructions to cancel unauthorized activity. It also guarantees individuals can access their account information and prioritizes continuity of coverage. The legislation also grants the Secretary authority to regulate field marketing organizations and third-party marketing organizations involved in the enrollment chain. These entities must adhere to a standard of conduct , including acting in the enrollee's best interest, and comply with strict marketing requirements, such as submitting materials for review and avoiding misleading practices. Additionally, the bill establishes a transparency framework through periodic audits of agents and brokers, sharing results with States, and maintaining a public list of suspended and terminated agents.
Accounting and auditingAdministrative law and regulatory proceduresCivil actions and liabilityConsumer affairsCriminal procedure and sentencingDepartment of Health and Human ServicesFraud offenses and financial crimesGovernment information and archivesHealth care costs and insuranceMarketing and advertising