Consumer Groups Worried About California Healthcare Enrollment Counselors

By Michael Klazema on 7/29/2013

As California gears up to launch Covered California, its new healthcare exchange, consumer groups are worried about protecting residents from falling victim to fraud or identity theft at the hands of unscrupulous enrollment counselors.

Originally, there were no provisions for performing background checks on the roughly 21,000 enrollment counselors that will be required to help the estimated 5.3 million uninsured Californians enroll in the healthcare exchange. This posed a concern because the counselors will have access to residents’ personal and financial information, including Social Security numbers, ID cards, and medical histories. Given that many of the people needing help enrolling in the program will likely have trouble speaking or reading English, there is definitely potential for abuse. Counselors could easily take advantage of these individuals and either steal their identities or convince them to purchase bogus healthcare products.

In June the exchange’s board did finally adopt regulations requiring background checks for all enrollment counselors. Hopefully they will be using a background check product that is as robust as the US OneSEARCH from US OneSEARCH is a national background check tool that compares a name and date of birth against a collection of over 450 million public criminal records taken from state and county sources in every state of the nation. Using US OneSEARCH enables employers to get a comprehensive picture of a job applicant’s criminal background and identify criminal records that may be relevant to their suitability for the job opening at hand. For example, someone with a conviction for fraud probably wouldn’t be a good candidate for a job as an enrollment counselor where may opportunities to commit fraud come with the job.

While consumer groups support background checks, they are also concerned that the results of the checks be used fairly. The exchange has not yet published their rules regarding what specific offenses may be used as a basis for denying certification as an enrollment counselor. Cary Sanders, a policy analysis director at California Pan-Ethnic Health Network, hopes the rules will not be too strict. “We don't want applicants from communities where the exchange really needs to reach out to, being sent away because they made a mistake in the past,” said Sanders. Applicants who fail the background check will be given a chance to appeal and explain their conviction or demonstrate evidence of reform.

Some consumer groups are also calling for the healthcare exchange to subject counselors to recurring background checks or ongoing criminal monitoring to ensure that they remain suitable for their positions year to year.

In addition to prescreening counselors in an effort to reduce the risk of fraud or identity theft, consumer advocates say that it is also crucial for the healthcare exchange board to set up a mechanism for reviewing complaints and prosecuting bad counselors.

According to data compiled by Javelin Strategy & Research, about 5.3 percent of American adults fall victim to identity theft annually. That translates to roughly 1.6 million victims in California every year. Hopefully, with proper screening and oversight protocols in place, California’s healthcare enrollment counselors won’t be adding to this figure.


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