Insurance Fraud Accountability Act
Sponsored By: Representative Rep. Ross, Deborah K. [D-NC-2]
Introduced
Summary
Stronger rules and penalties for agents, brokers, and marketing groups to curb fraud and protect consumers in assisted health plan enrollments. The bill creates a phased verification system, tougher fines, audits, and a public list to stop unauthorized or misleading enrollments.
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- Families and consumers: New verification steps for agent- or broker-assisted enrollments require clear, plain-language notices and give people access to their account information on a consumer-facing platform. Commissions tied to those enrollments are held until any inconsistencies are resolved. This regime phases in by a Secretary-set date but not later than January 1, 2029.
- Agents, brokers, and marketing organizations: Civil penalties expand, with fines starting at $10,000 and going up to $200,000 per affected individual for serious violations. The bill also allows criminal penalties for knowing fraud and requires registration, licensing, submission of marketing materials, and limits on referral-based pay unless criteria are met.
- Plans, Exchanges, and States: Issuers must be reported when terminated and the Secretary will run audits based on complaints and fraud indicators. The Secretary must share audit results with states and maintain a regular list of suspended and terminated agents and brokers.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 5 benefits, 0 costs, 0 mixed.
Tough penalties for dishonest insurance agents
If enacted, agents and brokers who knowingly give false enrollment information could face up to $200,000 per affected person and up to 10 years in prison. Negligent or disregard violations would bring $10,000 to $50,000 per person. Civil fines would use existing Social Security Act penalty procedures and could be in addition to other penalties.
Stronger checks on agent enrollments
The Secretary would require extra verification for enrollments or changes made by agents in federal-run marketplaces by a date no later than January 1, 2029. Agents would need to keep proof of your consent before enrolling or switching you. Commissions would be paid only after you fix any data issues, and insurers would see these records in a shared system. You would get fast, plain-language notices and a way to cancel unauthorized changes. The process would favor keeping your coverage unless you agree to end it, and agents would report any marketing firms involved.
Insurers must report plan terminations
If enacted, health insurers would have to tell HHS when a contract ends and is not replaced by a similar agreement, as defined in law. This reporting could help the government watch for changes that affect plan options and coverage continuity.
New rules for agents and marketers
If enacted, HHS would set rules with States on who can take part in the enrollment chain, by a date no later than January 1, 2029. Agents would have to act in your best interests. Marketing groups would need to report agent terminations, meet marketing and licensure rules, submit materials for review, register with HHS, and avoid confusing or misleading practices. Paying referrers would be limited unless they meet these rules.
Regular audits of insurance agents
If enacted, HHS would run audits of agents and brokers for marketplace plans by a date no later than January 1, 2029. Audits could start after consumer complaints or suspicious enrollment patterns. HHS would share results, refer possible fraud to State insurance departments, and keep a list of suspended or terminated agents for plans, Exchanges, and States.
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Sponsors & CoSponsors
Sponsor
Rep. Ross, Deborah K. [D-NC-2]
NC • D
Cosponsors
Rep. Castor, Kathy [D-FL-14]
FL • D
Sponsored 3/11/2025
Rep. Foushee, Valerie P. [D-NC-4]
NC • D
Sponsored 3/24/2025
Rep. Dingell, Debbie [D-MI-6]
MI • D
Sponsored 3/24/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 3/24/2025
Rep. Cohen, Steve [D-TN-9]
TN • D
Sponsored 1/14/2026
Roll Call Votes
No roll call votes available for this bill.
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