Earlier this month, The Washington Post covered a concerning report detailing how more than 6 million fraudulent enrollments were defrauding state-based and the federal exchange established under the Affordable Care Act.

A recent report from Paragon Health alleged that Pennsylvania had more than 21,000 improper enrollments. This troubling allegation appears to be consistent with materials Pennie presented to its board on June 5.

In materials presented to its board, Pennie noted that the cancellation of fraudulent policies had increased dramatically due to a sophisticated fraud scheme. In one case, an insurer had to review more than 4,500 policies for potential fraud.

I plan to introduce legislation that enhances fraud identification within Pennie by requiring documentation for enrollment in Pennie plans to include proof of residency or documented proof associated with the individual’s intent to reside in the Commonwealth.  Additionally, the legislation will require the establishment of an Office of Fraud Prevention within Pennie to solely focus on identifying and combatting fraud before it takes place.

My proposal will also require Pennie to report to the General Assembly the following information:

• Number of suspected fraud reports during the prior year
• Number of confirmed fraud reports during the prior year
• A copy of Pennie’s fraud policies including referral of suspected fraud to relevant authorities along with new procedures implemented by the authority to address fraud.
• Dollar amount associated with premium tax credits lost to fraud.

This proposal mirrors language adopted by the House, on June 9th, by a bipartisan vote of 132-70, and represents common-sense provisions to ensure the state takes every necessary step to prevent consumers from experiencing higher insurance costs due to fraud on the state exchange.

Please join me in in helping to reduce fraudulent Pennie claims by cosponsoring this bill.