Insurance Fraud Accountability Act

This bill amends the Patient Protection and Affordable Care Act to reduce fraudulent enrollments in qualified health plans by increasing penalties for agents and brokers, establishing new verification and consumer protection requirements, and regulating marketing organizations.

Sec. 2, Reduction of fraudulent enrollment in qualified health plans: This section adds civil penalties for agents or brokers who negligently provide incorrect information on an enrollment application, ranging from $10,000 to $50,000 per individual affected. It also adds civil penalties of up to $200,000 per individual for agents or brokers who knowingly provide false or fraudulent information, and criminal penalties (fine under title 18, imprisonment up to 10 years, or both) for knowing and willful false or fraudulent information.

Consumer protections: For plan years beginning by January 1, 2029, in Exchanges operated by the Secretary, the Secretary must establish a verification process for new enrollments and coverage changes submitted by agents or brokers. This process requires documentation of individual consent, payment of commissions only after inconsistencies are resolved, accessible information for health plans, timely notice to individuals of changes, account access for individuals, and reporting of third-party marketing organizations involved.

Required reporting: Health insurance issuers must report to the Secretary the termination of an issuer.

Authority to regulate field marketing organizations and third-party marketing organizations: The Secretary must establish criteria for States to allow field marketing organizations and third-party marketing organizations to participate in the enrollment chain. Criteria include a duty for agents and brokers to act in the enrollee's best interest, reporting of agent or broker terminations, and marketing requirements such as submission of materials for review, licensure, and registration.

Transparency: The Secretary, in coordination with States and the National Association of Insurance Commissioners, must implement oversight and enforcement processes including periodic audits of agents and brokers based on complaints, fraud patterns, and other factors, and share audit results with State insurance departments. The Secretary must also develop a process to regularly provide a list of suspended and terminated agents and brokers to health plans, Exchanges, and States.