Ohio Faces Growing Threat from Insurance Enrollment Fraud (Dispatch)

Ohio Faces Growing Threat from Insurance Enrollment Fraud

Tuesday, May 21st, 2024 Fraud Insurance Industry Legislation & Regulation Life & Health

Insurance enrollment fraud is becoming a significant issue in Ohio, as highlighted by the recent experience of Josh Smith, a resident physician in Cincinnati. Smith spent over two hours on the phone uncovering that his patient, Jill, had been fraudulently enrolled in an insurance plan by an unnamed broker. Jill, who earns too much to qualify for Medicaid but too little to afford private insurance, had been unable to afford her medications due to a $75 co-pay she did not authorize.

The Healthcare Marketplace confirmed that this is part of a larger trend, with nearly every other call this year related to broker fraudulently enrolling individuals without their consent. This systemic issue not only affects Jill but potentially hundreds of thousands of Americans, as brokers seek commissions from insurance companies even on zero-premium plans.

To combat this fraud, it is crucial for individuals to protect themselves by verifying the identity of anyone claiming to be from the Healthcare Marketplace and reporting any suspicious activities. Meanwhile, the Ohio Department of Insurance and federal authorities must take immediate action to regulate brokers and prevent further exploitation of vulnerable individuals.

Claims Pages Staff Writers are dedicated professionals covering a broad spectrum of insurance topics, including auto, catastrophe, education & training, fraud, legislation, liability, life & health, litigation, property, risk management, technology, underwriting, and workers' compensation. With over 25 years of distribution, our publication brings you accurate and timely information to keep you informed and ahead in the claims industry.

External References & Further Reading

Mid-America Catastrophe ServicesHancock Claims Consultants LLCU.S. Forensic

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