Fraud is delivering a blow to health insurance exchanges in the US

Health insurance fraud and abuse

Health insurance exchanges are working to fight fraud

Fraud in health insurance exchanges throughout the United States may draw more criticism toward the Affordable Care Act. The federal health care reform law was meant to bring health insurance coverage to millions of people through the establishment of exchange marketplaces. While the law has succeeded in this endeavor, these exchanges are struggling to combat fraud coming from those that want coverage and want to take advantage of the electronic system governing these exchanges.

Brokers are using fictitious information to enroll individuals that do not actually exist

One of the more problematic instances of fraud that exchanges are fighting comes from brokers enrolling non-existent individuals using fake information. Some brokers are also using the information of deceased individuals to enroll consumers that do not have the personal information they need to actually enroll themselves. Minors are also being enrolled in these exchanges without paternal authorization. Fraud is becoming more prevalent in exchanges, with those committing fraud exploiting the electronic enrollment system that these exchange use.

Electronic system makes it more difficult for exchanges to combat fraud

Health insurance fraud and abuseThe electronic system allows people to enroll in a relatively easy fashion, providing exchanges with information quickly. Because exchanges are digital, fraud detection is becoming more difficult, as enrollees can hide behind digital protections. In order to fight fraud, exchanges are beginning to employ advanced public records data and identity analytics, rooting out those who commit fraud and create a better marketplace for honest consumers and brokers that are using health insurance exchanges.

Insurance industry continues to combat fraud and recover from the losses that fraud creates

Fraud has been a major problem for the insurance industry for nearly as long as the industry itself has existed. Insurance fraud typically leads to major financial losses for insurers, which pressures them to increase insurance premiums in order to appropriately cope. Fraud is becoming more sophisticated, however, which is creating more problems for the insurance industry, especially as exchanges begin to play a larger role in the overarching health insurance market.

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