CMS is committed to protecting consumers in the Marketplace. CMS has received reports of consumers in HealthCare.gov states whose coverage was switched by agents and brokers without their knowledge. In response, CMS is taking swift actions to protect consumers from unauthorized activity by agents and brokers, and to root out bad actors who are violating CMS rules.
First and foremost, CMS continues to ensure that affected consumers receive assistance to minimize the impact from these unauthorized activities. These actions include retroactively restoring or cancelling coverage and updating tax forms to ensure consumers do not suffer adverse tax implications when unauthorized activity occurs. Consumers should call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) to report unauthorized activity associated with their Marketplace enrollment so the Marketplace can promptly resolve any coverage issues.
CMS suspends and terminates agents’ and brokers’ Marketplace privileges when they violate CMS rules or commit fraud. Our regulations require agents and brokers to obtain and document consumer consent before enrolling a consumer in Marketplace coverage or updating a consumer’s Marketplace coverage. CMS is working closely with state departments of insurance and law enforcement partners to share information and optimize resources to combat unauthorized and fraudulent activity in the Marketplaces.
In addition to enforcement activities, CMS is evaluating all regulatory, operational, and technological options to prevent unauthorized activity. CMS' technical teams are rapidly evaluating options for additional system controls to help block unauthorized or fraudulent activity in the near term. In the longer term, CMS will also evaluate options for system changes to help curtail unauthorized and fraudulent activities without creating roadblocks for consumers to obtain the coverage they need.