Jones, Groups See Fraud Potential in Covered California Enrollment

California Insurance Commissioner Dave Jones (D) and consumer advocacy groups are concerned about the potential for fraud and identity theft when individuals enroll in the state's health insurance exchange, AP/U-T San Diego reports (Lin, AP/U-T San Diego, 7/13).

Exchange Details

The exchange -- called Covered California -- primarily will serve individuals and small businesses.

Supporters hope that the exchange will function similarly to websites like Amazon and Expedia, allowing users to choose among various health plans through an easily navigable online store.

The exchange is expected to open for registration in October, and an estimated five million people will purchase plans through the exchange in 2014 (California Healthline, 7/1).

Privacy, Fraud Concerns

Jones and consumer groups say that the exchange is not doing enough to ensure that people hired as enrollment counselors -- individuals who will provide consumers with in-person assistance in signing up for health plans -- are adequately screened and monitored.

The network of more than 21,000 enrollment counselors could have access to consumers' personal and financial information, such as ID cards and medical histories.

According to Jones, the exchange does not have a plan for investigating any complaints that could arise once the counselors begin their work.

Jones said that it will be possible for the counselors to "obtain information that will allow them to build the trust they have with the individual they're working with and potentially sell them all manner of bogus products, steal their identity, gain access to certain assets they might have ... The list is virtually endless."

He added, "We can have a real disaster on our hands."

Meanwhile, Eric von Geldern -- president of the Northern California Fraud Investigators Association -- said he believes the exchange should implement an ongoing counselor monitoring system, rather than just initial qualifying requirements. He said the group is working with Covered California to ensure that consumers' safety and privacy are protected.

However, Cary Sanders -- policy analysis director for the California Pan-Ethnic Health Network -- said, "We don't want applicants from communities where the exchange really needs to reach out to being sent away because they made a mistake in the past. ... It doesn't have any bearing on their ability to provide the appropriate assistance to their communities."

Exchange's Response

Santiago Lucero -- a spokesperson for Covered California -- said that consumer safety is a primary concern for the exchange.

He added that the exchange board has adopted fingerprinting and background check requirements for the enrollment counselors, in addition to establishing a code of conduct.

Lucero also said the exchange will use "secret shoppers" and field monitors to assess enrollment counselors' performances (AP/U-T San Diego, 7/13).

Peggy Zuckerman
Since this large group of enrollment counselors have such an important and demanding role in the coming months, I would like to understand the training and testing that was used as the basis for their being hired. In this complex and changing situation, the purchaser of insurance must be absolutely able to rely 100% on the accuracy of the information given by the counselor. Certainly the training manuals and the testing--and the scores earned by the counselors should be readily available. Should I as an careful shopper turn to the counselor who has a 70% understanding of the materials or a 98% understanding? How do I protect myself from the person who may barely understand more than I do?
Kathy Janz
Jones is a politician on his way up the political ladder and has little insight into problem solving. As a state senator and even now, he fosters the underground economy- putting home care referral agencis that look identical to the agencies that employ their workers on the same footing license wise. in the meantime, then he went back and requested that the w/c rate go up for those that employ workers. in both cases, SEIU directed his actions. He is hollering about Anthem Blue Cross being part of the exchanges in CA , in the meantime, United Healthcare wants out of CA for individual coverage. While the insurance market makes a lot of money and needs some accounting, he is bent on creating a single payor because it is political expedient. He also wants to convert all home cae aide services into a IHHS type market - with little or no consumer protections. He needs to be intellectually honest and stop taking his orders from SEIU.

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