SummaCare Increased Monitoring of Broker Marketplace Activity

11-26-2024

Importance of Timely Response to Requests for Information

As you may be aware, there has been an increase in fraudulent activity in ACA (Marketplace) enrollments. Due to this, the Centers for Medicare & Medicaid Services (CMS) has increased monitoring of fraudulent activity with the intent of minimizing this activity.

If there is suspected fraudulent activity, CMS may suspend an agent’s FFM, and carriers must investigate these situations and do so within strict timelines to ensure compliance. To this end, if you are contacted by our Sales Compliance Team, it’s imperative that you respond within the timeline outlined in the communication. If our requests are not responded to in a timely manner, we potentially will not be able to provide CMS with broker explanation - and disciplinary actions may be taken by SummaCare and/or CMS if no response is given.

If you receive an email requesting compliance information, we will include a date and time that response is needed in the subject line and/or body of the request. Please note, some requests are URGENT and may require 12 hours or less response time on your part. Again, this is to ensure we are able to provide CMS with broker explanation within the appropriate timeline.

All this activity is to ensure consumer protection, and we appreciate your assistance should we request information regarding suspected questionable activity.