Coalition Against Insurance Fraud: Selling interstate invites scams

State oversight weakened, consumers vulnerable

I grew up in the Northeast, and now live in a Mid-Atlantic state. I understand Fall. The weather is crisp and the leaves turn colors. Happens every year.

Just like the leaves turning colors in the Fall, someone predictably come up with a supposedly great idea: let consumers buy health coverage from insurers across state lines.

The argument is always the same: Interstate sales increases competition and reduces costs for consumers. This sounds workable on paper. The latest go-around was raised in this past week’s presidential debate as the fall leaves tumbled — just like consumer protections.

Problem is, interstate sales open the door wide for fraud, and water down consumer protection. And, most people advocating this system usually don’t include important and necessary protections when pushing their interstate plans.

Yes, neighboring states can legally create partnerships that allow insurers to cover consumers in any state within the partnership. Yet partnerships have strict, built-in legal protections when states agree to work together. Insurance regulators know who’s doing business. Networks also offer consumers choices of doctors and facilities.

These protections and coverages may not exist under a blanket permit for consumers to buy coverage in any state.

Consumers don’t know what insurance regulator to reach for help. And would the regulator in the state where the consumer lives have much incentive to help if the health insurer is domiciled another state? Would the regulator where the insurer is domiciled help a consumer living in a different state?

We already see crooks peddling bogus health insurance to unsuspecting consumers and small businesses. This problem would be magnified if interstate sale of health insurance was allowed without strict and well-defined oversight.

Insurers must be state-licensed to do business in a given state. How can state oversight properly protect consumers if anyone can offer insurance to any consumer in any other state?

Who makes certain the insurer is solvent and can do business in another state? And, would an insurer in one state have an adequate network of doctors, hospitals and pharmacies to cover the health needs of consumers in another state?

These questions are raised every time interstate health-insurance sale is broached. Yet we never hear answers — just the simplistic nostrum that interstate sales will help reduce healthcare costs.

Don’t just spoon out more words like falling autumn leaves — prove that consumers would be better protected.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.



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Association of Certified Fraud Specialists: Membership Overview

The Benefits of Becoming a Member

– Low-Cost, Anti-Fraud Training

– Career Development Tools

– Exclusive ACFS Publications

– National Conferences

– Networking Opportunities

The Many Ways to Get Involved as a Member

1. REGULAR MEMBERS (Certified)

These   are individual anti-fraud professionals who have sought member program   and have been granted the Certified Fraud Specialist (CFS) designation.

2. ASSOCIATE MEMBERS (Non-Certified)

These are individual anti-fraud professionals who seek access to the publications, but are not yet certified.

3. STUDENT MEMBERS (Non-Certified Undergraduates)

These   are college students who are actively enrolled full time, in an   institution of higher education, in a fraud field of study that may now join the ACFS as a Student Member.

4. RETIRED (Non-Practicing CFS’s)

These   are Certified Fraud Specialists (CFS’s) that are retiring from being   active in the field but wish to remain actively involved in the ACFS.

Corporate Membership Program

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Follow the Links Below for More Information About our Membership Program

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– Rewards for members

– View our awards and award winners

– Application fees and membership dues

– New and Newly Certified Members

The ACFS is a non-profit organization helping members who are public and private sector investigators, auditors, law enforcement, attorneys, and other risk management professionals CONNECT.

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The ability to innovate based on newly acquired knowledge is the key to helping both fraud prevention professionals and citizens help keep the companies they work for safe.

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