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Life Health > Health Insurance > Health Insurance

What if you lie to a PPACA exchange?

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If you lie to one of the new public health insurance exchange programs, you could end up having to pay huge fines.

In theory, 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.”

HHS could also impose 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 information.

Officials at the Centers for Medicare & Medicaid Services (CMS) — an arm of HHS — summarize the Patient Protection and Affordable Care Act (PPACA) civil monetary penalty (CMP) rules in a new slidedeck aimed at “assisters,” or people who help consumers apply for coverage through the exchange system.

See also: Witnesses: PPACA income verification is a mess.

See also: Jail and prison are different.

Officials also interpreted the CMP rules earlier this month, in another slidedeck aimed at exchange helpers.

CMS created slidedecks to help exchange helpers understand the relevant parts of a big batch of final PPACA regulations completed in May.

Elsewhere in the new slidedeck, officials note that:

  • A public exchange is supposed to provide a written notice of annual open enrollment and benefits eligibility redetermination sometime between the first day of the month before the open enrollment period begins and the first day of the open enrollment period. For the 2015 plan year, exchanges must provide the notices sometime between Oct. 1 and Nov. 15.
  • HHS has created “special enrollment period” (SEP) access to individual “qualified health plan” (QHP) coverage for people with non-calendar year individual market plans that expire in 2015, and for women who lose Medicaid coverage related to pregnancy.
  • Voluntary termination of coverage does not give consumers the right to apply for individual QHP coverage through a SEP.
  • HHS defines “termination” of coverage as “action taken after the effective date that ends on an enrollee’s coverage effective on a date after the effective date.”
  • HHS defines “cancellation” of coverage as “type of termination that ends a [qualified individual's] coverage on or before the effective date, thus rendering coverage as never effective.”


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