Health Insurance Fraud

Have you been enrolled in a health insurance plan through the Marketplace by an insurance agent or broker without your knowledge or consent? Did your federal income tax return indicate that you had health insurance coverage with an insurance company through the Marketplace—sometimes referred to as Obamacare, the "Exchange," Healthcare.gov, or the Affordable Care Act—and now you owe the IRS a repayment of the premium tax credit, even though you didn’t sign up for this coverage?

In some instances, unscrupulous agents are enrolling clients into new health plans to collect commissions, while sometimes changing the clients' mailing addresses, emails, and phone numbers. This prevents clients from being alerted to the fraudulent behavior by the new company.

Another avenue for unauthorized activity occurs when consumers mistakenly click on an ad on social media. When they do so, agents or agencies connected to the ads enroll the consumer in a health plan and collect a fee.

Tips to Remember

• If you see an ad on social media or someone reaches out to you offering cashback, gift cards, grocery money, or other perks, it’s likely a scam. Information you share could be used without your consent.
• Whenever you are speaking with a licensed insurance agent, ask them for their license number. You can contact NCDOI to verify license status of an insurance agent. 
• Make sure when you visit the Health Insurance Marketplace, the web address reads: https://www.HealthCare.gov. There are many other companies that may try to mislead you and falsely give the impression that they’re associated with the Marketplace or HealthCare.gov. There are also websites that look the same or have a similar web address and use the words “healthcare” and “Marketplace,” but aren’t the official, trusted resource.
• If on another website to purchase a Marketplace plan, make sure you’re on an authorized website before entering any personal or contact information for a health insurance quote. Visit HealthCare.gov/direct-enrollment/ to check if you’re on an authorized website. These are the only websites approved by the Marketplace to provide consumer quotes and help enroll consumers in Marketplace coverage. 
• For free, non-biased personal help with Marketplace health coverage, call the Marketplace Call Center at 1-800-318-2596 – 24 hours a day/ 7 days a week (except holidays). Help is available in other languages.  Marketplace Call Center representatives do not get any incentives for signing you up.
• Know the Marketplace Open Enrollment dates. No one can enroll you after Open Enrollment ends unless you have a qualifying life event or are eligible for a Special Enrollment Period.
• Look for official government seals or logos. If you’re getting help from a Marketplace assister, ask to see certifications.
• Be suspicious of anyone who charges you a fee to enroll in coverage. Marketplace assisters, like Navigators and certified application counselors, shouldn’t ask you for money to help enroll you in a Marketplace plan.
• Write down and keep a record of the name or names of anyone who helps you, who they work for, and their phone number, street address, mailing address, email address, and website.
• Ask questions if any information is unclear or confusing and do not sign anything you do not understand. 
• Compare coverage options carefully before picking a health plan.
• Never give your personal information to someone who comes to your home without your permission, even if they say they’re from the Marketplace.
• Keep personal and account numbers private. Don’t give your Social Security Number (SSN) or credit card or banking information to companies you didn’t contact or in response to advertisements. Note: If you get help from a legitimate Marketplace assister, they may need certain personal information, like your SSN, to help you enroll.