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Obamacare Insurance Agent Pockets $9000 a Month From Fraudulent Applications

Home/Healthcare News/Obamacare Insurance Agent Pockets $9000 a Month From Fraudulent Applications

Obamacare Insurance Agent Pockets $9000 a Month From Fraudulent Applications

by Nate D’Amico | ATR | August 17, 2015 | image credit: gotcredit.com

Obamacare Insurance Agent Pockets $9000 a Month From Fraudulent Applications

Sovereign Solutions Editor’s Note:

Subsidies, or “other peoples’ money,” tend to skew markets and provide ample opportunity for fraudulent applications and ill-gotten gain for some. Here is just one example, one in which we see a smaller player in the Liars, Looters, and Losers circuit.

Fraudulent applications, fraudulent claims, fraudulent billing, fraudulent [you fill in the blank] becomes quite possible when the actual end-user of services does not directly pay!

We need not only concern ourselves with the “Big Boys,” but also lower level individuals and organizations that feed off of the indirect pay model most of us utilize in purchasing healthcare services! The current purchasing model is not efficient and certainly does NOT feature transparent prices, or market price discovery.

What if people generally paid for healthcare services directly with private cash or credit?

Such would go a long way in reducing fraudulent applications and all else. Third party payers can never do as good a job as individual, direct buyers on average. 

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In yet another Obamacare scandal, a North Carolina insurance agent is being investigated by state officials for illegally signing up over 600 individuals in North and South Carolina for insurance through the Healthcare.gov marketplace. This likely fraud allowed the agent to pocket almost $9,000 a month on commissions.

In order to qualify for federal health insurance subsidies, which covers most or all of premiums for low-income people, one must have at least $11,700 in expected income over a year. According to a report by CNBC, the agent was reportedly instructing low-income individuals to apply for the subsidies with projected income generated from panhandling, selling drugs, and even prostitution.

This unusual activity was brought to the attention of North Carolina officials after an insurance software company in California noticed a high volume of applications with addresses at homeless shelters and expected income listed at the threshold of $11,700. Once brought to light, healthcare company Aetna immediately ceased their relationship with the agent and will investigate the matter fully, as does the administrator of Obamacare and the Healthcare.gov exchange, the Centers for Medicare and Medicaid Services.

The agent justified his actions as legal and claims he was simply trying to educate low-income people about eligibility under the new Affordable Care Act laws. However, had the enrollments not been called into question and subject to an investigation, he would have made about $9,000 per month in commissions, or almost $110,000 over the year from these 600 enrollments alone. This curious case calls into question other enrollments facilitated by this agent, but also whether this practice is occurring throughout the rest of the country.

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WHAT DO YOU THINK?

Do you have any objections, thoughts, concerns, or contributions? I REALLY WANT TO KNOW. Help me to make this a conversation!

Together we can map out better solutions and truly navigate clearer paths towards quality services, low prices, and better lives.

Oh! And as always, if you find this post useful, do me and so many others a huge favor. When it comes to this kind of information: share and share alike! Information is meant to be disseminated wide and far.

Sovereign Liberty Solutions

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By | 2017-03-28T10:34:47-04:00 September 17th, 2015|Categories: Healthcare News|Tags: , , , , |0 Comments

About the Author:

My name is Matthew. I am founder of and manage Sovereign Liberty Solutions. I am a proponent of free, voluntary association and expression. I understand that there is no single exception or excuse to violate this with the initiation of force, fraud, and coercion. I welcome a genuine dialogue & seek information, news, analysis, and, of course, solutions, whether it be on the individual level or a more voluntary association [group] or even "national" one.

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