CMS blocks private sector enrollment sites from ACA marketplace
CMS received more than 200,000 complaints in the first six months of the year about such actions.
Photo: Mo Mo Productions/Getty Images
Federal regulators have blocked two private sector enrollment websites from accessing consumer information through the federal Affordable Care Act marketplace, with the Centers for Medicare and Medicaid Services citing "anomalous activity."
CMS received more than 200,000 complaints in the first six months of the year about such actions.
The agency said in a written statement that it had suspended the two sites – Benefitalign and Inshura – "while the anomalous activity is researched to ensure the EDE partners are in compliance with CMS data standards." EDE stands for "enhanced direct enrollment" and refers to websites approved to integrate with healthcare.gov.
In a separate development, the two websites, which insurance brokers use instead of the federal healthcare.gov site to enroll clients in Affordable Care Act plans, are mentioned in an ongoing civil lawsuit filed by attorneys representing consumers and agents who claim they've been harmed by enrollment schemes.
WHAT'S THE IMPACT
On Aug. 9, CMS posted an updated list of websites approved to integrate with the federal ACA marketplace that no longer included Benefitalign and Inshura. As a result, insurance agents can't use the websites to enroll customers or make changes to their ACA plans.
Private sector enrollment sites were first allowed to integrate with healthcare.gov data under the Trump administration. About a dozen such sites are now approved to connect with the federal system.
TrueCoverage, an insurance call center that also does business as Inshura, and Benefitalign are subsidiaries of Speridian Global Holdings of California. Both firms are mentioned in the lawsuit first filed in April in the U.S. District Court for the Southern District of Florida. The suit alleges that people and organizations engaged in misleading advertising or made changes to ACA policies without the express permission of consumers, with the goal of racking up commissions.
Late on Aug. 16, that case was amended to add allegations and defendants, including Benefitalign. The other enrollment website, Inshura, is not listed as a defendant, although it is run by TrueCoverage.
The Aug. 16 filing alleges that TrueCoverage or Speridian Technologies, another subsidiary of Speridian Global Holdings, used the Benefitalign or Inshura websites to access U.S. consumers' personal information, then sent it to marketers in India and Pakistan. The allegation, if true, would violate agreements the private sector websites made with the federal government to gain approval to operate, the suit contends.
THE LARGER TREND
In recent weeks, lawmakers have called on CMS to do more and introduced legislation to increase penalties for agents who enroll people in plans without authorization. The large number of complaints from victims of the schemes have caught the attention of House Republicans, who on June 28 requested investigations by the Government Accountability Office and the Office of Inspector General at the Department of Health and Human Services.
CMS has since taken actions to short-circuit unscrupulous agents and call centers.
Until last month, agents using the approved private sector enrollment sites could access consumer information via healthcare.gov with only a name, birth date and state of residence. CMS now requires three-way calls among agents, consumers and the healthcare.gov helpline when agents new to a policy try to make a change.
Many legitimate insurance agents are urging an additional fix used widely by state ACA enrollment systems: requiring two-factor authentication before consumer information can be accessed or changed by agents.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
