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Congress·In Committee·4 months ago

Senate Panel Eyes Up to $200K Fines, Prison Time for Health Plan Enrollment Fraud

Also known as: Insurance Fraud Accountability Act

Legislative Progress

✓ Filed
Review
Senate
House
President

Impacts

Negative Impacts(2)
Small Business Owner
Hurts
Gig Worker
Hurts

Key Points

  • Creates new fines for agents and brokers who submit wrong information for health plan sign-ups, especially when it affects each person’s application.
  • Sets much bigger penalties when an agent or broker knowingly submits false information, including fines up to $200,000 per affected person and possible prison time (up to 10 years).
  • Requires a federal verification step for certain health plan sign-ups handled by agents or brokers, including proof the consumer agreed (like a consent form).
  • Delays agent/broker commission payments until the consumer fixes eligibility or paperwork issues, and requires timely notices so people can quickly cancel unauthorized changes.
  • Adds new oversight tools, including audits based on complaints or suspicious patterns, and a shared list of agents/brokers who have been suspended or terminated.
HealthcareConsumer Protection

Milestones

2 milestones3 actions
Nov 6, 2025Senate

Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.

Mar 12, 2025Senate

Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Mar 12, 2025

Introduced in Senate

What Happens Next

Projected impacts based on AI analysis

Plan years beginning on a date set by the Secretary, but no later than 2029 plan year (deadline Jan 1, 2029)

Federal Exchange creates a new verification step for agent/broker-submitted enrollments and plan changes

If an agent/broker signs you up or changes your plan, they may have to show proof you agreed (like a standard consent form). This can reduce unauthorized changes but may add steps before coverage updates go through.

Same start as the verification process; deadline no later than Jan 1, 2029

Commission payments to agents/brokers get delayed until application issues are cleared

Agents/brokers may follow up more to fix paperwork or eligibility “inconsistencies.” Consumers might get more requests for documents before everything is finalized.

When the Secretary implements the verification process (deadline no later than Jan 1, 2029)

Consumers receive quicker notices when enrollment, agent of record, or premium tax credits change

You’re more likely to find out fast if something changed on your Marketplace account, and you’ll get plain-language steps to cancel changes you didn’t approve.

Implemented with the new verification rules; deadline no later than Jan 1, 2029

A consumer-facing way to check account details outside the Exchange website becomes available (website/tech platform or hotline)

If you used an agent/broker platform to enroll, you should still be able to see key details (plan, agent of record, changes) and get help by phone to spot and stop unauthorized activity.

For plan years beginning on a date set by the Secretary, but no later than Jan 1, 2029

Federal oversight adds periodic audits of agents and brokers and shares results with states

Bad actors are more likely to be caught based on complaints or suspicious patterns. Legit agents may face more checks and paperwork to prove they followed rules.

After the Secretary sets up the process; deadline no later than Jan 1, 2029

Regular lists of suspended/terminated agents and brokers are sent to plans, Exchanges, and states

It becomes harder for a suspended broker to quietly keep enrolling people. Consumers may be steered away from known bad actors.

Related News

4 articles
Financial Regulation News·12 months ago

Legislation would introduce criminal penalties for health insurance fraud

Proposed by Sen. Ron Wyden and Reps. Deborah Ross and Kathy Castor, the Insurance Fraud Accountability Act creates criminal penalties for brokers who change ACA plans without consent. It establishes civil fines up to $200,000 and potential prison time for knowingly submitting false information.

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Florida Politics·12 months ago

Delegation for 3.14.25: Kathy Castor seeks to penalize insurers for unauthorized ACA plan changes

Rep. Kathy Castor reintroduced the Insurance Fraud Accountability Act to address 'system-gaming' by brokers in Florida and nationwide. The bill mandates a consent verification process and requires brokers to act in the best interest of the customer to prevent unauthorized enrollment changes.

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Fierce Healthcare·over 1 year ago

Payer Roundup: Wyden introduces bill to institute criminal penalties against insurance brokers

Senate Finance Committee Chair Ron Wyden led a group of senators in introducing the Insurance Fraud Accountability Act. The bill targets 'predatory' brokers who enroll individuals in plans without permission to collect commissions, proposing strict new financial and criminal consequences.

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Source Information

Document Type

Congressional Bill

Official Title

Insurance Fraud Accountability Act

Bill NumberS 976
Congress119th Congress
ChamberSenate
Latest ActionCommittee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.

Sponsor

Cosponsors

(10)
D: 10

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.