CHARLOTTE — Families who rely on the Affordable Care Act marketplace say rogue insurance agents are adding, changing and even canceling their health coverage without them knowing.
Ashley Akra says she had health insurance through the ACA a few years back.
Then, she got a job and health insurance through work. She thought the ACA plan was a distant memory. That was until this past March.
She says she went to CVS to pick up medicines for her daughter. “They’re like, ‘She’s not on your insurance. You have this plan,’ which is not my plan through my job,” she told Action 9 investigator Jason Stoogenke.
She says she did some digging and figured out an insurance broker had signed her up for an ACA plan behind her back. She says the government subsidized that policy 100%. So, the good news is she didn’t lose any money. The bad news is she never saw any paperwork about the plan, paperwork that might have tipped her off, and, she says, the IRS noticed something was wrong and is auditing her.
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“Overwhelmed. Never-ending. Very vulnerable that someone was able to take our information and use it and use it for their own financial gain,” she said.
In Georgia, Tiesha Foreman says someone switched her to a new plan, canceling her old policy. The way she tells it, she also found out because of her daughter, not at the pharmacy, but at the pediatrician.
“It’s stressful and scary and it’s embarrassing,” she said. “I kept trying to call on the phone, trying to talk to the marketplace to get them to understand I wasn’t doing these applications. I didn’t know who this agent was.”
An Ohio couple says they went to the pharmacy to pick up Randy Delaney’s insulin. “When I got to the pharmacy, you can imagine my shock when they told us it was $1,096,” his wife, Lorie, said.
They say they spent months trying to get to the bottom of it, only to find out someone switched their health plan multiple times without consent. “It’s just like somebody is in there just messing with your life every day,” she said.
In the first eight months of this year, the federal government says nearly 275,000 people complained someone changed or enrolled them in plans without their knowledge.
Attorney Jason Doss filed this class action lawsuit on behalf of consumers, claiming families who rely on the ACA marketplace are victims of a multimillion-dollar scheme.
“I believe this is the largest health insurance fraud case ever,” he said. “The problem is, what if the bad guy owns the enrollment platform? They have the keys to the castle.”
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What he means is this: agents and brokers need licenses to access the ACA database. But once they’re in, they’re in. An insurance agent says bad actors didn’t need much information after that to manipulate people’s plans.
“All they need is a first name, last name, date of birth, and state,” insurance agent Callie Navrides said.
The lawsuit argues that one way criminals got clients’ information was through pop-up ads, advertising free money. Foreman says her husband clicked a link and ended up speaking with someone at a company called TrueCoverage. “He had no idea that this was happening,” she said.
In addition, the agents earn a commission: about $20 for each ACA policy. So, if they switch you, they make money.
A former insurance agent worked for TrueCoverage at a Florida call center and agreed to talk to WSOC’s sister station. “Someone has to from the inside tell the truth about what happens,” she said. “The top performers were people that were lying bluntly and they were telling people that they were going to get that cash.”
Since the lawsuit, federal officials say they suspended 850 insurance agents and brokers for “reasonable suspicion of fraudulent or abusive conduct” related to this. They blocked TrueCoverage from the marketplace in August. The feds say they’ve added new protections to combat the problem and are asking in their proposed rules 2026 for broader power to suspend bad agents.
TrueCoverage emailed us:
“TrueCoverage takes these allegations very seriously and is responding appropriately. While we cannot comment on ongoing litigation, we strongly believe that the allegations are baseless and without merit.
“Compliance is our business. The TrueCoverage team records and reviews every call with a customer, including during Open Enrollment when roughly 500 agents handle nearly 30,000 calls a day. No customer is enrolled into any policy without a formal verbal consent given by the customer. If any customer calls in as a result of misleading content presented by third party marketing vendors, agents are trained to correct such misinformation and action is taken against such third-party vendors.”
TrueCoverage and the other companies the lawsuit accuses filed a motion to dismiss.
They deny wrongdoing and claim the consumers who had gaps in their coverage didn’t suffer any tangible loss.
It’s hard to protect yourself, so take all the usual precautions:
- Be suspicious of high-pressure calls and emails, especially those promising free money.
- Guard your personal information.
- If you’re on Medicare, remember: you don’t need the ACA marketplace.
- When you get a doctor’s bill or prescription, look at the paperwork. Make sure you recognize the insurance they used. Akra says that would have helped in her case.
Report Marketplace Fraud to 800-318-2596.
For more information on protecting yourself, click here.
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