Identifying Fraud: Communication from the Health Insurance Marketplace Processing Center

Since October 1, 2013, consumers, assisters, and even Health Insurance Marketplace Call Center representatives have used the Marketplace paper application as a way to capture information while the Centers for Medicare and Medicaid Services (CMS) continues improving HealthCare.gov. Recently, the Michigan Department of Insurance and Financial Services responded to concerns of fraud related to phone calls from people claiming to be Health Insurance Marketplace representatives.

Legitimate Phone Calls
The U.S. Department of Health and Human Services has contracted with a third-party firm named Serco to process Marketplace paper applications. All applications that are mailed to the processing center in London, Kentucky, are reviewed, and those which are incomplete or present a complex family structure are set aside for follow-up. Serco began contacting applicants by phone three weeks ago to complete or clarify application information.

If you are contacted by Serco about your Marketplace paper application, your caller ID may read one of the following:

• Health Insurance MP

• 606-260-4191 (Kentucky)

• 636-698-6320 (Missouri)

• 479-877-3203 (Arkansas)

• 580-354-7707 (Oklahoma)

The Serco employee will state that he/she is calling from the Health Insurance Marketplace regarding your recent health insurance application and give you his/her name and agent ID number. You should write this down and keep this for future reference. The employee will use three pieces of information to verify that you are the correct person to speak with about your application, including requesting the last four digits of your social security number.

If you would prefer to not provide certain information over the phone, you can tell the Serco employee this at any time during the call. CMS will then mail you a letter explaining the next steps for processing your application and your options for providing the needed information.

Serco will make three attempts within seven days to contact you, leaving voicemails each time they are unsuccessful. If unsuccessful, a notice will be mailed to you that contains next steps for processing your application. There is no phone number you can call to contact Serco.

It is important to know that the Marketplace will be unable to determine eligibility if an application is incomplete.

Fraudulent Phone Calls
Consumers have reported cases of fraud in which people posing as Marketplace representatives have contacted them via phone to sell private unsubsidized plans. You should never give your personal health information to someone who calls or comes to your home uninvited, even if that person says they are from the Marketplace. While the Health Insurance Marketplace may ask for your income or salary, it will never ask you for information about your personal health or financial institution. If you have been contacted by a suspicious caller seeking your personal information, contact Michigan’s Health Insurance Consumer Assistance Program at 877-999-6442 or DIFS-HICAP@Michigan.gov.

If you have any questions about the instructions in this article, please contact Julie Tatko, MPCA Program Coordinator, Outreach, Education & Enrollment.

 

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