Legis Daily

Insurance Fraud Accountability Act

USA119th CongressHR-2079| House 
| Updated: 3/11/2025
Deborah K. Ross

Deborah K. Ross

Democratic Representative

North Carolina

Cosponsors (5)
Debbie Dingell (Democratic)Steve Cohen (Democratic)Kathy Castor (Democratic)Eleanor Holmes Norton (Democratic)Valerie P. Foushee (Democratic)

Energy and Commerce Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
The "Insurance Fraud Accountability Act" aims to significantly reduce fraudulent enrollments in qualified health plans offered through Affordable Care Act Exchanges. It achieves this by strengthening accountability for agents and brokers, implementing new consumer protection measures, and establishing regulatory oversight for marketing organizations involved in the enrollment process. The bill introduces both civil and criminal penalties for those who provide incorrect or false information during enrollment. Specifically, the bill amends the Patient Protection and Affordable Care Act to impose substantial civil penalties on agents or brokers for negligent or knowing provision of false information, with fines reaching up to $200,000 per individual for knowing violations. Furthermore, agents or brokers who knowingly and willfully provide false or fraudulent information could face criminal penalties, including fines and up to 10 years imprisonment. To bolster consumer safeguards, the bill mandates a new verification process for agent- or broker-assisted enrollments in federally-operated Exchanges, requiring explicit individual consent and delaying commission payments until any enrollment inconsistencies are resolved. This legislation also grants the Secretary of Health and Human Services authority to regulate field marketing organizations and third-party marketing organizations participating in the "chain of enrollment." These organizations and their agents will be subject to new criteria, including a duty to act in the enrollee's best interests , marketing material review, and licensure requirements. To ensure transparency and compliance, the Secretary will implement periodic audits of agents and brokers based on complaints or suspicious enrollment patterns, sharing findings with State insurance departments. Additionally, a regular list of suspended and terminated agents and brokers will be provided to qualified health plans, Exchanges, and States.
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Timeline

Bill from Previous Congress

HR 118-10095
Insurance Fraud Accountability Act
Mar 11, 2025
Introduced in House
Mar 11, 2025
Referred to the House Committee on Energy and Commerce.
Nov 6, 2025

Latest Companion Bill Action

S 119-976
Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.
  • Bill from Previous Congress

    HR 118-10095
    Insurance Fraud Accountability Act


  • March 11, 2025
    Introduced in House


  • March 11, 2025
    Referred to the House Committee on Energy and Commerce.


  • November 6, 2025

    Latest Companion Bill Action

    S 119-976
    Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.

Health

Related Bills

  • S 119-976: Insurance Fraud Accountability Act
  • HR 119-6575: CommonGround for Affordable Health Care Act
  • HR 119-6010: To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.
  • HR 119-6501: Bipartisan Health Insurance Affordability Act
Accounting and auditingAdministrative law and regulatory proceduresCivil actions and liabilityConsumer affairsCriminal procedure and sentencingDepartment of Health and Human ServicesFraud offenses and financial crimesGovernment information and archivesHealth care costs and insuranceMarketing and advertising

Insurance Fraud Accountability Act

USA119th CongressHR-2079| House 
| Updated: 3/11/2025
The "Insurance Fraud Accountability Act" aims to significantly reduce fraudulent enrollments in qualified health plans offered through Affordable Care Act Exchanges. It achieves this by strengthening accountability for agents and brokers, implementing new consumer protection measures, and establishing regulatory oversight for marketing organizations involved in the enrollment process. The bill introduces both civil and criminal penalties for those who provide incorrect or false information during enrollment. Specifically, the bill amends the Patient Protection and Affordable Care Act to impose substantial civil penalties on agents or brokers for negligent or knowing provision of false information, with fines reaching up to $200,000 per individual for knowing violations. Furthermore, agents or brokers who knowingly and willfully provide false or fraudulent information could face criminal penalties, including fines and up to 10 years imprisonment. To bolster consumer safeguards, the bill mandates a new verification process for agent- or broker-assisted enrollments in federally-operated Exchanges, requiring explicit individual consent and delaying commission payments until any enrollment inconsistencies are resolved. This legislation also grants the Secretary of Health and Human Services authority to regulate field marketing organizations and third-party marketing organizations participating in the "chain of enrollment." These organizations and their agents will be subject to new criteria, including a duty to act in the enrollee's best interests , marketing material review, and licensure requirements. To ensure transparency and compliance, the Secretary will implement periodic audits of agents and brokers based on complaints or suspicious enrollment patterns, sharing findings with State insurance departments. Additionally, a regular list of suspended and terminated agents and brokers will be provided to qualified health plans, Exchanges, and States.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline

Bill from Previous Congress

HR 118-10095
Insurance Fraud Accountability Act
Mar 11, 2025
Introduced in House
Mar 11, 2025
Referred to the House Committee on Energy and Commerce.
Nov 6, 2025

Latest Companion Bill Action

S 119-976
Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.
  • Bill from Previous Congress

    HR 118-10095
    Insurance Fraud Accountability Act


  • March 11, 2025
    Introduced in House


  • March 11, 2025
    Referred to the House Committee on Energy and Commerce.


  • November 6, 2025

    Latest Companion Bill Action

    S 119-976
    Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.
Deborah K. Ross

Deborah K. Ross

Democratic Representative

North Carolina

Cosponsors (5)
Debbie Dingell (Democratic)Steve Cohen (Democratic)Kathy Castor (Democratic)Eleanor Holmes Norton (Democratic)Valerie P. Foushee (Democratic)

Energy and Commerce Committee

Health

Related Bills

  • S 119-976: Insurance Fraud Accountability Act
  • HR 119-6575: CommonGround for Affordable Health Care Act
  • HR 119-6010: To amend the Internal Revenue Code of 1986 to extend and modify the enhanced premium tax credit, and for other purposes.
  • HR 119-6501: Bipartisan Health Insurance Affordability Act
  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
Accounting and auditingAdministrative law and regulatory proceduresCivil actions and liabilityConsumer affairsCriminal procedure and sentencingDepartment of Health and Human ServicesFraud offenses and financial crimesGovernment information and archivesHealth care costs and insuranceMarketing and advertising