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119-s-976119th CongressWALLET

Insurance Fraud Accountability Act

Sponsored By: Senator Wyden, Ron [D-OR]

In Committee

Summary

Tougher enforcement against fraudulent ACA enrollments. This bill would sharply increase penalties for bad actor agents and brokers, require verification and documented consent for broker-led enrollments, and give HHS new authority over field and third-party marketing groups.

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  • Consumers and families: New enrollment checks must include documented consent, clear notices and a consumer website or hotline. Plans cannot disenroll people without their consent and commissions are withheld until inconsistencies are resolved.
  • Agents, brokers, FMOs and TPMOs: Negligent false information can trigger civil fines of $10,000 to $50,000 per affected person. Knowing violations can carry civil fines up to $200,000 per person and criminal penalties including fines and up to 10 years in prison. Firms face registration, marketing review, duty-of-best-interest rules, and limits on referral pay.
  • Issuers, exchanges and states: Issuers must report terminations to HHS. The Secretary may audit enrollment patterns, coordinate with states and the National Association of Insurance Commissioners, and share lists of suspended or terminated agents with plans and exchanges.

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 3 benefits, 1 costs, 0 mixed.

Consumer protections for agent enrollments

If enacted, the bill would require HHS to verify enrollments and coverage changes submitted by agents who would earn a commission. This would apply for plan years the Secretary sets but no later than January 1, 2029. Agents would need documented consumer consent before enrollment and could not be paid until any inconsistencies are fixed. Consumers would get timely plain-language notices about changes, and could see account and agent-of-record details on a website or hotline. The process would also bar disenrolling someone without their consent.

Audits and reporting for agents

If enacted, the Secretary would set up audits and oversight of agents and brokers for plan years beginning on or after a date the Secretary sets, but not later than January 1, 2029. Audits could follow consumer complaints or suspicious enrollment patterns. The Secretary would share audit results with State insurance departments and give plans, Exchanges, and States lists of suspended or terminated agents. The bill would also require issuers to report certain terminations to the Secretary.

Rules for agents and marketing groups

If enacted, HHS would set minimum standards for agents, brokers, field marketing organizations, and third-party marketing firms for plan years the Secretary sets, but not later than January 1, 2029. Rules would require acting in enrollees' best interests, reporting agent terminations and reasons, following marketing rules, registering with the Secretary, and limiting referral-based pay unless strict criteria are met. The bill would also add clear definitions for terms like "chain of enrollment," "field marketing organization," and "marketing materials."

Large fines for fraudulent agents

If enacted, agents and brokers who give wrong enrollment information could face big civil and criminal penalties. Negligent errors could bring fines of $10,000 to $50,000 per affected person. Knowingly false information could bring fines up to $200,000 per person. Knowing and willful fraud could also bring criminal fines and up to 10 years in prison.

Sponsors & CoSponsors

Sponsor

Wyden, Ron [D-OR]

OR • D

Cosponsors

  • Sen. Duckworth, Tammy [D-IL]

    IL • D

    Sponsored 3/12/2025

  • Sen. Hirono, Mazie K. [D-HI]

    HI • D

    Sponsored 3/12/2025

  • Sen. Klobuchar, Amy [D-MN]

    MN • D

    Sponsored 3/12/2025

  • Sen. Murray, Patty [D-WA]

    WA • D

    Sponsored 3/12/2025

  • Sen. Schatz, Brian [D-HI]

    HI • D

    Sponsored 3/12/2025

  • Sen. Shaheen, Jeanne [D-NH]

    NH • D

    Sponsored 3/12/2025

  • Sen. Smith, Tina [D-MN]

    MN • D

    Sponsored 3/12/2025

  • Sen. Welch, Peter [D-VT]

    VT • D

    Sponsored 3/12/2025

  • Sen. Van Hollen, Chris [D-MD]

    MD • D

    Sponsored 3/12/2025

  • Sen. Blumenthal, Richard [D-CT]

    CT • D

    Sponsored 11/5/2025

  • Sen. Warnock, Raphael G. [D-GA]

    GA • D

    Sponsored 3/17/2026

Roll Call Votes

No roll call votes available for this bill.

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