Rise Seen in Health Insurance Scammers

It might be a man on his laptop at a Saturday flea market, accepting cash to help people sign up for subsidized health coverage on Healthcare.gov.

It might be a sign directing callers to an 800 number where they can get help choosing an Affordable Care Act plan — for a fee.

Or it might be a cardboard poster attached to a telephone pole offering “Real insurance. Not Obamacare.” 

In any case, advocates for the uninsured warn, if it asks for money, it's probably a scam to prey on low-income Texans seeking mandated insurance coverage under President Barack Obama’s signature health law.

Nonprofit workers in the Rio Grande Valley say they’ve seen an increase this year in sales tactics — including the examples cited above — that are at best unethical and at worst illegal, charging low-income Texans fees for assistance they are entitled to receive for free.

“When you’re talking about hard-working, resource-limited people who are not aware they may be charged, that’s crossing the line," said Jose Medrano, a regional director for Enroll America, an advocacy group offering free information to people signing up for health insurance.

The Obama administration has spent up to $11 million per year on Texas “navigators,” the state and federally regulated workers who help people sign up for coverage. They are barred from charging a fee. Licensed insurance agents are exempt from that law, but industry experts said agents typically do not charge sign-up fees because they are paid on commission.

But this year, with adults facing a minimum $695 tax penalty for remaining uninsured, a growing number of con artists have exploited people’s ignorance about the health law, charging fees from $25 to $100 for signup assistance, said Cliff Clark, program director for Weslaco-based MHP Salud.

“Now that we’re in the third year [of open enrollment], more people have figured out how to scam and found out, ‘Oh hey, I can make some money off this,’” he said.

The lack of clarity about how Texans can access subsidized health insurance could hamper the federal government’s efforts at a time when it is specifically eyeing the state for more signups. Roughly 19 percent of Texans are uninsured, the highest share of any state, according to U.S. Census data.

More than one million Texans signed up for Affordable Care Act coverage in 2015, but the rate of enrollment lagged behind other states with large uninsured populations, like Florida.

Texas navigators face greater scrutiny than their counterparts in other states. In 2013, after a series of videos showed navigators in Dallas encouraging enrollees to lie on their applications, state lawmakers mandated extra regulations for the assisters. Navigators were required to receive 20 hours of state-specific training in addition to the federal training requirement of 20 to 30 hours, to undergo background checks and to provide proof of identity — which some critics called excessive and politically motivated.

State Rep. Chris Turner, D-Grand Prairie, said state officials should bear some of the blame for the increase in scam artists because the state didn't provide “sufficient education and outreach” about Texans' options under the Affordable Care Act.

“Because of the lack of straightforward, fact-based information, that creates an opening, I think, for some of these unscrupulous actors to step in,” Turner said. “And that’s just wrong.”

Advocacy groups are launching an aggressive education campaign in response to the reportedly higher number of rogue assisters. But in the less-affluent Rio Grande Valley region in South Texas, where the majority of reports have surfaced, many people lack reliable Internet access or have difficulty speaking English, making outreach more difficult, Medrano said. 

A spokesman for the Texas Department of Insurance said the agency has not received any navigator-related complaints since open enrollment began last month and encouraged Texans to report alleged fraud to the state’s consumer help telephone line.

“Navigators are funded through federal grants and should not request any kind of payment from the consumers they assist,” agency spokesman Ben Gonzalez said.