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Submission: On May 21 via manual from US — Scanned from US
Submission: On May 21 via manual from US — Scanned from US
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Skip to main content Display Advertisement Sign in Mail 24/7 Help For premium support please call: 800-290-4726more ways to reach us Mail Sign in * Subscriptions * Animals * Business * Elections * Entertainment * Fitness * Food * Games * Health * Home & Garden * Lighter Side * News * Online Classes * Science & Tech * Shopping * Sports * Weather Sign in * Subscriptions * Animals * Business * Elections * Entertainment * Fitness * Food * Games * Health * Home & Garden * Lighter Side * News * Online Classes * Science & Tech * Shopping * Sports * Weather AN INSURANCE FRAUDSTER LEFT MY PATIENT IN TEARS. ENROLLMENT FRAUD A DANGER TO OHIO. Gannett Josh Smith May 21, 2024 at 5:34 AM Medicaid is difficult to get for single adults, and often patients must acquire private health insurance. Josh Smith is a resident physician in Cincinnati. The clock ticks on — I have now spent more than two hours on the phone. Being on hold is part of life as a physician, a routine irritation of securing care for patients, but this call is anything but routine. I was not calling to cover care. I was calling to cancel coverage. MY PATIENT BECAME A VICTIM Our health insurance system is complicated, a patchwork mess that leaves a gap. In Ohio, a single adult making less than $20,783 per year qualifies for Medicaid. Any more, and they have to find private coverage. If they can’t afford private insurance, they are out of luck. One of my patients, Jill, falls into this gap. A hardworking woman in her 40s, she works six days a week, visits her parents in their nursing home and maintains a long-distance relationship. Jill makes $2,200 per month, too much to qualify for Ohio Medicaid, but too little to afford private health insurance premiums and prescription drugs. We’ve talked at length about her struggles to find coverage. So I’m taken aback when, at our most recent visit, Jill tearfully revealed that she had been without her medications for weeks due to an unaffordable $75 co-pay. Having a co-pay implies having insurance. Jill confirmed that she never signed up for coverage. Our clinic’s team confirmed that our records list her as uninsured. Shockingly, her pharmacy shared that she has health insurance. The quest for answers led to hours of calls with insurance companies, the Healthcare Marketplace and Jill’s care team. The truth was startling - Jill was enrolled by an unnamed broker on an unidentified website. The Marketplace representative summarized, “This seems to be insurance fraud.” AN UNNAMED BROKER GOT MY PATIENT'S INFORMATION This revealed a growing epidemic of insurance enrollment fraud. Advertisement The Healthcare Marketplace supervisor shared that nearly every other call this year has been related to a broker fraudulently, and without consent, signing an individual up for a Marketplace plan. In January 2022, Julie Appleby with KFF News reported on newly-proposed federal regulations for insurance brokers, in response to “situations when consumers are enrolled without their knowledge or consent.” In the article, Tara Straw of the Center on Budget and Policy Priorities is quoted, “The profit motive is a really important thing to keep in mind as to why this happens at all,’ [and she] noted that insurers pay commissions [to brokers] even on zero-premium plans.” It is unclear how the unnamed broker got Jill’s information. It is unclear how many Ohioans are similarly affected. But if every other call to the member services supervisor for the Healthcare Marketplace is related to this, then hundreds of thousands of Americans are being defrauded for the sake of insurance company and broker profits. Josh Smith is a resident physician in Cincinnati. The scale of this issue necessitates government intervention, and the Ohio Department of Insurance must take action. WHAT CAN YOU DO TO PREVENT INSURANCE ENROLLMENT FRAUD While we wait for our leaders to act, there are steps that you can take. “Protect Yourself from Marketplace Fraud & Scams” on Healthcare.gov details steps to take to avoid such situations. If you receive a call from someone claiming to be from the Healthcare Marketplace, write down their first name and agent ID number. If there is ever a doubt, do not engage, do not provide personal information - hang up! Report any concerns to the Healthcare Marketplace Call Center. If you have a primary care provider, talk to them about your concerns. Jill’s is one of many stories that highlight a systemic issue of health insurance fraud that requires urgent attention. As the clock continues to tick, we need action to put a stop to fraudulent practices that harm the health and wellbeing of countless Americans. Josh Smith is a resident physician in Cincinnati. This article originally appeared on The Columbus Dispatch: Health insurance enrollment fraud hitting Americans hard Show comments Advertisement IN OTHER NEWS Entertainment Entertainment USA TODAY DANIEL STERN FELT 'REALLY BAD' FOR MACAULAY CULKIN, WAS 'ALMOST KILLED' BY COCAINE ON… Entertainment People ANNE HATHAWAY WEARS A GAP — YES, GAP — GOWN WITH DAZZLING BULGARI BLING Food Food Cheapism 8 REGIONAL BBQ STYLES THAT WILL MAKE TEXANS FAINT Food Simply Recipes SOUTHERN LIVING’S 1-INGREDIENT UPGRADE FOR BETTER BLT SANDWICHES (IT'S MY FAVORITE) Lighter Side Lighter Side Associated Press AT THE PET GALA, FASHION GOES TO THE DOGS: SEE THE PHOTOS Lighter Side Cheapism RAT PACK HAUNTS YOU CAN STILL VISIT (NOT JUST IN VEGAS) News News USA TODAY SEVERE WEATHER THREAT FIRES UP AGAIN TODAY: 25M AT RISK FOR TORNADOES IN CENTRAL US News Associated Press POLICE BREAK UP PRO-PALESTINIAN CAMP AT THE UNIVERSITY OF MICHIGAN Sports Sports USA TODAY HOW MANY POINTS DID CAITLIN CLARK SCORE LAST NIGHT? ANKLE INJURY, TECHNICAL FOUL IN L… Sports CNN Sports BIZARRE WEATHER CONDITIONS DISRUPT TENNIS MATCH WITH ANDY MURRAY ON BRINK OF DEFEAT Weather Weather CBS News HEAT WAVE IN MEXICO LINKED TO "MASS DEATHS" OF MONKEYS Weather Associated Press ITALIAN WOMEN'S PRISON, HUNDREDS OF RESIDENTS EVACUATED AFTER 4.4 MAGNITUDE QUAKE IN … Advertisement Advertisement RELATED ARTICLES Show comments Advertisement Advertisement RELATED ARTICLES Show comments Advertisement Advertisement RELATED ARTICLES Show comments Advertisement * * Feedback * Help * Join AOL * * Accessibility * EU Digital Services Act * Terms and Privacy Policy * Privacy Dashboard * * About Us * About our Ads * Advertising * Sitemap * * * * * © 2024 Yahoo. All rights reserved.