Legis Daily

Insurance Fraud Accountability Act

USA119th CongressS-976| Senate 
| Updated: 11/6/2025
Ron Wyden

Ron Wyden

Democratic Senator

Oregon

Cosponsors (11)
Jeanne Shaheen (Democratic)Mazie K. Hirono (Democratic)Tammy Duckworth (Democratic)Amy Klobuchar (Democratic)Chris Van Hollen (Democratic)Patty Murray (Democratic)Tina Smith (Democratic)Brian Schatz (Democratic)Peter Welch (Democratic)Raphael G. Warnock (Democratic)Richard Blumenthal (Democratic)

Health, Education, Labor, and Pensions Committee, Homeland Security and Governmental Affairs Committee, Permanent Subcommittee on Investigations

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
This bill, the "Insurance Fraud Accountability Act," aims to strengthen the integrity of the Patient Protection and Affordable Care Act by reducing fraudulent enrollments in qualified health plans. It achieves this by imposing stricter penalties on agents and brokers, enhancing consumer protections, and increasing regulatory oversight of the enrollment process to prevent deceptive practices. The bill significantly increases penalties for agents and brokers involved in providing incorrect or false information during enrollment. Agents or brokers who negligently provide incorrect information face civil penalties ranging from $10,000 to $50,000 per individual, while knowingly providing false information incurs civil penalties up to $200,000 per individual and potential criminal charges including imprisonment. To protect consumers, the bill mandates a verification process for agent or broker-assisted enrollments in federally-operated Exchanges. This includes requiring individual consent, delaying commission payments until enrollment inconsistencies are resolved, and ensuring timely notifications of enrollment changes with instructions to cancel unauthorized activity. It also guarantees individuals can access their account information and prioritizes continuity of coverage. The legislation also grants the Secretary authority to regulate field marketing organizations and third-party marketing organizations involved in the enrollment chain. These entities must adhere to a standard of conduct , including acting in the enrollee's best interest, and comply with strict marketing requirements, such as submitting materials for review and avoiding misleading practices. Additionally, the bill establishes a transparency framework through periodic audits of agents and brokers, sharing results with States, and maintaining a public list of suspended and terminated agents.
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Timeline

Bill from Previous Congress

S 118-4767
Insurance Fraud Accountability Act
Mar 11, 2025

Latest Companion Bill Action

HR 119-2079
Introduced in House
Mar 12, 2025
Introduced in Senate
Mar 12, 2025
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Nov 6, 2025
Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.
  • Bill from Previous Congress

    S 118-4767
    Insurance Fraud Accountability Act


  • March 11, 2025

    Latest Companion Bill Action

    HR 119-2079
    Introduced in House


  • March 12, 2025
    Introduced in Senate


  • March 12, 2025
    Read twice and referred to the Committee on Health, Education, Labor, and Pensions.


  • November 6, 2025
    Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.

Health

Related Bills

  • HR 119-6575: CommonGround for Affordable Health Care Act
  • HR 119-2079: Insurance Fraud Accountability 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 CongressS-976| Senate 
| Updated: 11/6/2025
This bill, the "Insurance Fraud Accountability Act," aims to strengthen the integrity of the Patient Protection and Affordable Care Act by reducing fraudulent enrollments in qualified health plans. It achieves this by imposing stricter penalties on agents and brokers, enhancing consumer protections, and increasing regulatory oversight of the enrollment process to prevent deceptive practices. The bill significantly increases penalties for agents and brokers involved in providing incorrect or false information during enrollment. Agents or brokers who negligently provide incorrect information face civil penalties ranging from $10,000 to $50,000 per individual, while knowingly providing false information incurs civil penalties up to $200,000 per individual and potential criminal charges including imprisonment. To protect consumers, the bill mandates a verification process for agent or broker-assisted enrollments in federally-operated Exchanges. This includes requiring individual consent, delaying commission payments until enrollment inconsistencies are resolved, and ensuring timely notifications of enrollment changes with instructions to cancel unauthorized activity. It also guarantees individuals can access their account information and prioritizes continuity of coverage. The legislation also grants the Secretary authority to regulate field marketing organizations and third-party marketing organizations involved in the enrollment chain. These entities must adhere to a standard of conduct , including acting in the enrollee's best interest, and comply with strict marketing requirements, such as submitting materials for review and avoiding misleading practices. Additionally, the bill establishes a transparency framework through periodic audits of agents and brokers, sharing results with States, and maintaining a public list of suspended and terminated agents.
View Full Text

Suggested Questions

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

Timeline

Bill from Previous Congress

S 118-4767
Insurance Fraud Accountability Act
Mar 11, 2025

Latest Companion Bill Action

HR 119-2079
Introduced in House
Mar 12, 2025
Introduced in Senate
Mar 12, 2025
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Nov 6, 2025
Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.
  • Bill from Previous Congress

    S 118-4767
    Insurance Fraud Accountability Act


  • March 11, 2025

    Latest Companion Bill Action

    HR 119-2079
    Introduced in House


  • March 12, 2025
    Introduced in Senate


  • March 12, 2025
    Read twice and referred to the Committee on Health, Education, Labor, and Pensions.


  • November 6, 2025
    Committee on Homeland Security and Governmental Affairs Senate Permanent Subcommittee on Investigations. Hearings held.
Ron Wyden

Ron Wyden

Democratic Senator

Oregon

Cosponsors (11)
Jeanne Shaheen (Democratic)Mazie K. Hirono (Democratic)Tammy Duckworth (Democratic)Amy Klobuchar (Democratic)Chris Van Hollen (Democratic)Patty Murray (Democratic)Tina Smith (Democratic)Brian Schatz (Democratic)Peter Welch (Democratic)Raphael G. Warnock (Democratic)Richard Blumenthal (Democratic)

Health, Education, Labor, and Pensions Committee, Homeland Security and Governmental Affairs Committee, Permanent Subcommittee on Investigations

Health

Related Bills

  • HR 119-6575: CommonGround for Affordable Health Care Act
  • HR 119-2079: Insurance Fraud Accountability 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