Crazy Consent Story, although ACA...

[yankee466]

Thx, I definately will file with the DA. I'm in the middle of returning CMS's email requesting more info, just redoing original post from here with proper grammar/english.
I'll follow though 100% because it pisses me off.

We'll just be thankful he changed health plans and you saw it. he could have just as easily kept you on the same plan and just removed the current agent and added his name instead. Your agent would never catch it unless he/she/they are religioously monitoring commission statements every month, and if they are like me, there is not enough time in the day to keep up with thousands of clients status every month.

Fraud is growing worse all the time, and I have seen no evidence that CMS cares

 

[cador]

We'll just be thankful he changed health plans and you saw it. he could have just as easily kept you on the same plan and just removed the current agent and added his name instead. Your agent would never catch it unless he/she/they are religioously monitoring commission statements every month, and if they are like me, there is not enough time in the day to keep up with thousands of clients status every month.

Fraud is growing worse all the time, and I have seen no evidence that CMS cares

That's what he did, renewed me with the same Commmunity Health Choice plan that my agent did a month ago. Just changed the agent, not the plan.

 

[wolf5150]

The only reason I even noticed there was a problem in my case was because I check my BOB routinely, I noticed an 8 month chargeback on my commission statement. It goes without saying, always review PIF's and commission statements.

 

[UKTX]

I feel your frustration...however its not likely to go anywhere irrespective of who you report it to.....It's annoying healthsherpa allows this ease of change of AOR in their software/site.

I think it would be pretty simple of healthsherpa's end to remove this ability to just go in and update/change an AOR with a) such limited information and b) no plan change.

This type of activity could be shut down real quick if they adopted a couple of simple changes to their system.

 

[cador]

I feel your frustration...however its not likely to go anywhere irrespective of who you report it to.....It's annoying healthsherpa allows this ease of change of AOR in their software/site.

I think it would be pretty simple of healthsherpa's end to remove this ability to just go in and update/change an AOR with a) such limited information and b) no plan change.

This type of activity could be shut down real quick if they adopted a couple of simple changes to their system.

I hear you, but hope you're incorrect, as this agent needs his license suspended, and a fine. I've heard of agents getting fined for alot less.
This isn't a situation like the outfits running Facebook ads and having the customer sign and then enrolling them without talking to them or letting them know what's going on, which is bad enough. This is 100% fraud where I talked to him about which carriers the Dr's office accept and which they do not, and he illegally used my info to enroll me into health insurance. I didn't even know he was a health iins agent, and did not speak to him about that. That's fraud, not just breaking some CMS rules.

 

[wolf5150]

I hear you, but hope you're incorrect, as this agent needs his license suspended, and a fine. I've heard of agents getting fined for alot less.
This isn't a situation like the outfits running Facebook ads and having the customer sign and then enrolling them without talking to them or letting them know what's going on, which is bad enough. This is 100% fraud where I talked to him about which carriers the Dr's office accept and which they do not, and he illegally used my info to enroll me into health insurance. I didn't even know he was a health iins agent, and did not speak to him about that. That's fraud, not just breaking some CMS rules.

At a minimum, notify the carriers involved.

 

[cador]

OK, I have filed with CMS, Tx Dept of Ins, Tx States Atty Office, Community Health Choice fraud reporting, and have found the founding Dr's email, and his CEO's and will be emailing copy of my complaint to them, you would think they wouldn't want to do business with and/or be associated with someone of his ethics. Their administrator didn't seem to care too much, let see if they do. I am waiting till next week as I want to get my last RX of Mounjaro before they ban me from their practice.
I've always had the mindset I would never want to be the cause, or contribute to an agent losing their license and affecting their way to make a living. Over my 25 yr in the biz, I've seen some stuff, but never reported anyone.
But this pisses me off. The TDI asked me what I wanted as a resolution, I stated "lose his license". Frig him!
A couple guys told me nothing will happen to him, I hope that's incorrect. I'd report to him his upline but I can't find it.

 

[cador]

I feel your frustration...however its not likely to go anywhere irrespective of who you report it to.....It's annoying healthsherpa allows this ease of change of AOR in their software/site.

I think it would be pretty simple of healthsherpa's end to remove this ability to just go in and update/change an AOR with a) such limited information and b) no plan change.

This type of activity could be shut down real quick if they adopted a couple of simple changes to their system.

I was hoping you were wrong, but it's looking like you were not too far off. No one has GAF so far, but I'm not giving up! I want this POS punished in some way, needs his license taken away and fined. I know agents that have done alot less and lost their license.

Update-

For the directly filed complaint with Comm Health, I rec'd a letter a couple of weeks that they found no fraud was committed and closed complaint, wtf? I filled out an appeal, agreed to physically attend a complaint trial (wrote that I would drive anywhere I need to). I will pursue it.

For the Tx Dept of Ins, I rec'd letter last week that they closed it as well, wtf? They included a Comm Health (CH) letter that stated CH found no fraud, that my chosen plan is in place (yes it is, because I caught the agents fraud and my long term ins agent changed it back) and they have closed the investigation. The TDI letter states they found no evidence of Fraud or mishandling of information. BULLSHIT!
The whole deal is slimy. I had Comm Health's Manager of Broker Services call me later part of Dec, we spoke at length about this. He told me he was sending it to their fraud dept and I'd be hearing from them, which I never did. I forwarded him the New Enrollment email I rec'd with the agents name on it that alerted me of the fraud, he confirmed he rec'd it while we were on the phone. Comm Health's letter to the State say's that this gentleman tried to reach me 3 times and left a vm but never was able to contact me. What? We spoke about 20 minutes, and there is no frigging way he called me and left vm as I rec'd no missed calls, and no vm. I have phone records to prove it. I do not understand that claim, it's just strange, and a lie. I've emailed him 3 times this week asking him to call me, and asking if he rec'd my previous emails requesting a phone call, no reply.
I have left 2 vm's for the TDI person that signed the TDI letter (there is no signature/contact info on CH's letter, just Compliance Dept) and is in charge of my case, she won't call me back. I'm calling her SV next week, this is ridiculous. I will get them to re-investigate and dole out due punishment.
It seems the state is concentrating on Wellspire (who did nothing wrong/illegal), my complaint is clearly against the agent, not Wellspire. I do not believe they have even contacted the agent, Idiots!

Filed it with CMS as well. They did call me, gave me case # and told me it was going to their fraud dept but be patient as they are very busy, I bet they are. I will start calling them tomorrow, I hear they are my best chance of anything getting done of this situation.

The Atty's Gen office sent me (ole Paxton has his own problems, lol) a letter I need to manually write the complaint/file it as their website is not working. I have not done that yet, but will.

I cannot believe Wellspire, the Dr's group that is referring this POS has not, and is not taking any action and is still referring this clown. They have some liability in this guy screwing their patients around.

I am going to follow through with it till I get some satisfaction knowing this POS has rec'd some kind of punishment.

 

[yankee466]

I reported fraud like this several times…and nothing ever came if it. One client received a call from the carrier that she was put on without her knowledge, and was told they had recorded permission from the other agent, and when she asked to hear it, they refused. She wanted to know why she would ever agree to be put on a high deductible Bronze plan at $0 premium when I already had her on $0 premium silver plan with $0 deductible. Crickets, and she was pissed


Good luck in your endeavor, as no one appears to give a s**t about all the fraud going on.

 

[cador]

I reported fraud like this several times…and nothing ever came if it. One client received a call from the carrier that she was put on without her knowledge, and was told they had recorded permission from the other agent, and when she asked to hear it, they refused. She wanted to know why she would ever agree to be put on a high deductible Bronze plan at $0 premium when I already had her on $0 premium silver plan with $0 deductible. Crickets, and she was pissed


Good luck in your endeavor, as no one appears to give a s**t about all the fraud going on.

Yea, isn't this on our FFM/MA/AHIP certifications, how we are required to report Fraud/Abuse etc? With lots of questions we have to get right on how, where, when, etc, and the penalties for not doing so.
Then you report it and they (to the same that are writing these certifications) don't gaf.