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 new civil penalties for agents or brokers who negligently provide incorrect information ($10,000 to $50,000 per individual) and for those who knowingly provide false or fraudulent information (up to $200,000 per individual). It also adds criminal penalties for knowing and willful false or fraudulent information (fine under title 18, imprisonment up to 10 years, or both).

Sec. 2(b), Consumer protections: For plan years beginning by January 1, 2029, the Secretary must establish a verification process for new enrollments or coverage changes submitted by agents or brokers in federally operated Exchanges. This includes requiring documentation of individual consent, delaying commission payments until inconsistencies are resolved, notifying individuals of changes, providing account access, and requiring agents or brokers to report third-party marketing organizations involved. The Secretary must prioritize continuity of coverage and not disenroll individuals without consent.

Sec. 2(c), Authority to regulate field marketing organizations and third-party marketing organizations: The Secretary must establish criteria for States to allow agents, brokers, field marketing organizations, and third-party marketing organizations to participate in enrollment. Criteria include a duty to act in the enrollee's best interest, reporting of agent or broker terminations, marketing requirements, registration with the Secretary, and a ban on compensating unqualified individuals for referrals or services.

Sec. 2(d), Transparency: The Secretary must implement a process for oversight and enforcement of agent and broker compliance, including periodic audits based on complaints, fraud indicators, and other factors, and sharing 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 qualified health plans, Exchanges, and States.