🔥BREAKING: I just learned how common-sense the
@CMSGov actions were to remove phantom enrollees in federal exchange states.
Here is what they did. And this should not be controversial in any way, unless you support fraud, sending billions of dollars to insurers on behalf of phantoms, and large taxpayer-financed commissions for unscrupulous brokers who made things up on applications, including creating fake applicants.
First, enrollees had to meet 4 criteria: 1) have an application submitted by an agent or broker that lacks a Social Security number or immigration number; 2) have no record of actual contact with the insurer; 3) pay $0 in premiums themselves (meaning taxpayers paid 100% of the premium); and 4) have NO medical claims. Of note, the combination of these factors is a red flag for a potential phantom enrollee.
Second, assuming those 4 criteria were met, the insurer sent the enrollee two forms of notice and gave them 30 days to respond.
Third, if there was no response, CMS determined the enrollment to be unauthorized, and it was canceled. (Of note, insurers have large incentives to get in touch with the enrollee to keep that subsidy payment flowing.)
IMPORTANT DETAIL THAT SAFEGUARDS LEGITIMATE ENROLLEES: CMS has a safeguard in place. If a legitimate enrollee was affected, they can contact the call center, provide a verified Social Security number, and be reinstated.