Healthcare Insurance Fraud – How Could the Affordable Care Act Impact You and Your Business?

On October 1, the Federal Government will launch the Health Care Exchange Marketplace, the vessel by which Americans will apply for subsidized insurance coverage under the Affordable Care Act (ACA). The Marketplace supports enrollees in their search for insurance coverage by allowing them to shop multiple providers in their area with one application.

To facilitate the data exchange between enrollees and providers, the Federal Government has built a Secured Data Hub to store application data. This data hub will contain everything a fraudster would need to steal an identity. It will hold all personal information such as Names, Addresses, Social Security Numbers, Dates of Birth, Income and Household information. Once the state exchanges are actively accepting applicants on October 1, the Marketplace’s data hub will contain millions of consumer identities.

However, in a recent Reuters’ editorial, Sharon Begley – a Senior Correspondent reported that there are major delays in the security testing of this new data hub. Should it ever be breached, now or in the future, the results would be disastrous. Hackers would have access to millions of consumer profiles to sell or use at their disposal. Even a small leak of the information stored in the Marketplace could have a dramatic effect on American businesses.

Other ways fraudsters are taking advantage of the Affordable Care Act is through the confusion many have over the upcoming healthcare law changes. Scams range from people pretending to be government workers and requesting bank account numbers in order to set up health care plans to phony websites and emails pretending to be part of the Affordable Care Act.  Seniors as well as lower-income individuals are just two groups being highly targeted through these efforts.

Once your information is exposed to a fraudster, it can be used in businesses all over the country – particularly in account origination, fund transfers, tax refunds and credit purchases. The potential for loss could be detrimental to organizations of all shapes and sizes.

As technology evolves, so does the cunning fraudster. It is always going to be important to protect your business (and your customers) by employing an identity verification and fraud prevention solution that goes beyond compliance and provides an aggressive approach to fighting fraud. Learn more about how IDology’s innovative solution allows you to stay ahead of the fraud landscape.

Other tips from to help avoid Healthcare Insurance scams:

  1. Stay informed. As always, the more informed you are, the better. The Center for Medicare & Medicaid Service’s is a good place to start.
  2. Government officials will never ask you to wire money, give out your bank account information or load funds onto a prepaid card. If they do – it’s a scam.
  3. If you ever receive an unsolicited call, email or fax claiming that you need to purchase a new Medicare card or update your personal information, hang up and report the event to the FTC.
  4. Be cautious of any potentially phishing websites (that might look official) – do your research as they might even contain the actual seal of the real insurance exchanges, but are really trying to load malware onto your computer and collect your information.
  5. If you do mistakenly present a fraudster with your personal information, inform your banks, credit cards and bureaus so they can be on the lookout for potential identity thieves.

News & Events

Upcoming Events