What are the two most common types of fraud committed by agents nationwide on Exchanges?

The recognition of Unauthorized Enrollment (UE) and Unauthorized Plan Switching (UPS) as the two most common types of fraud committed by agents is crucial in understanding the landscape of fraud in Exchanges. Unauthorized Enrollment occurs when an agent enrolls individuals in health plans without their consent or knowledge. This action not only violates ethical standards but also exposes consumers to financial liabilities and unwanted healthcare costs.

Unauthorized Plan Switching involves agents changing a consumer’s health plan without their explicit approval, often to shift them to a plan that offers the agent a higher commission. Both forms of fraud undermine the integrity of the healthcare exchange system by distorting consumer choices and eroding trust in the marketplace. Recognizing these acts as prevalent forms of fraud allows organizations and regulators to focus their efforts on prevention, better training, and monitoring of agents to ensure compliance with established healthcare policies and practices.