Health Agents Gave False Information About Non-ACA Plans in GAO Audit

According to an undercover audit completed by the nonpartisan Government Accountability Office, some health insurance brokers provided misleading or false information to potential customers about whether their plans covered preexisting conditions.

The audit was requested by Senate Democrats with the intention of determining whether companies selling health plans exempt from Affordable Care Act coverage requirements were being honest about the limitations of the plans, which tend to be cheaper but aren’t comprehensive and typically don’t cover preexisting conditions, according to The Hill. Eight sales representatives engaged in potentially deceptive marketing practices out of the 31 representatives called by employees of the GAO posing as customers looking for health insurance that covered their preexisting conditions.  In those instances, representatives sold GAO employees limited benefit plans that don’t cover preexisting conditions, including memberships to health care discount programs that don’t actually qualify as insurance. In one instance, a GAO employee asked about ObamaCare plans, but was falsely told by a sales representative that ObamaCare was no longer in effect in 2020. Some of the sales representatives refused to let GAO employees see the policy documents before they agreed to buy it.

The investigators made some calls inside the open enrollment period and some at other times of the year, and they always said they had a serious pre-existing condition, such as diabetes, or heart disease. Some health insurance brokers claimed the undercover GAO agents’ pre-existing conditions were covered when the health plan documents they received after purchase said otherwise. One rep told the undercover investigator that a limited-benefit plan would cover emergency room visits completely, even though the plan provided no benefits for emergency room treatment. The health care cost sharing ministry rep also claimed that the investigator was unlikely to be able to get individual major medical insurance in the investigator’s state, even though several ACA-compliant individual major medical insurance policies were available in that state, according to Think Advisor.

Sen. Bob Casey (D-Pa.), the highest-ranking member on the Senate’s Special Committee on Aging, who requested the GAO report, said,

We need to make sure that these companies and brokers are held accountable, and that consumers understand their options, when I say held accountable— these people should be in jail prosecuted.”

Sen. Casey said he would introduce a bill allowing the Federal Trade Commission to crack down on deceptive online advertising for “junk” plans, tightening consumer disclosure requirements. The report issued by the GAO was sent to the HHS, which stated that it plans to conduct a review of the sales representatives who were identified as misleading customers and take action as appropriate.