Beware of Insurance Marketplace Fraud
The Centers for Medicare and Medicaid Services has advised consumers of possible uptick in improper enrollments including agents and brokers signing patients up for health plan coverage without their knowledge. This includes switching them from a plan they already have into a new one or into an additional plan.If you have reason to believe there is any suspicious activity related to one or more of your patients, Oscar Health wants to ensure you’re fully equipped with the resources and information needed to support them.
Where can you report this information?
If your patients mention a concern of fraud and believe they were enrolled in or switched to a plan on the Federally Facilitated Marketplace (FFM) without their knowledge or consent, please advise them to call the CMS Marketplace Call Center at 1-800- 318-2596 (TTY: 1-855-889-4325).What Oscar can (and will) do to help
If the CMS Marketplace representatives are alerted that a patient has been enrolled or has had a plan switched without their knowledge, CMS representatives will contact us to:- Review the report and ensure the patient’s unauthorized plan is cancelled if appropriate
- Notify the consumer of the outcome of the review
- Make sure patients switched without authorization are re-enrolled in a plan that they choose
- Note: Members should be aware that they may be responsible for any services received not covered by another health plan