Penalties Steep for False Information on Exchange

Prior to the open enrollment in 2013 and especially the weeks leading up to the very first day of available healthcare on the Affordable Care Act (ACA) healthcare exchange January 1, 2014, there was much discussion of the safety of individuals personal information on such a massive website, and also much discussion of individuals falsifying information in order to qualify for a much richer subsidy in their healthcare plan.

In order to help deter giving false information when individuals sign up to one of the new public health insurance exchange programs, the U.S. Department of Health and Human Services (HHS) could impose a maximum penalty of $250,000 per exchange application “for any person who knowingly and willfully provides false information.”

In principle, HHS could also levy a $25,000 penalty on “any person who fails to provide correct information, where such failure is attributable to negligence or disregard of any rules or regulations of the HHS secretary,” and on any person who “knowingly or willfully uses or discloses” private exchange data.

Officials at the Centers for Medicare & Medicaid Services (CMS), an arm of HHS, review the ACA civil monetary penalty (CMP) rules in a new presentation (link below) directed at assisters or people who help consumers apply for coverage through the exchange system.

Link to summary of ACA civil monetary penalty: http://marketplace.cms.gov/help-us/market-standards-rule.pdf

Source: CMS.gov