Health insurance scams leave thousands with large medical debts and no coverage

New York City, August 28, 2003--A recent unprecedented increase in unauthorized and illegal health insurance plans, spurred by rising health care costs and increasing numbers of uninsured, has left approximately 100,000 people with millions of dollars in medical debts and no coverage, according to a new report from The Commonwealth Fund. Companies selling phony insurance collect premiums from enrollees but fail to pay health care providers. With no safety net, such as a state guaranty fund, to pay medical claims when these plans become insolvent, victims are often left with huge medical debts.

"These scams prey on people who are seeking access to affordable health insurance coverage," said Karen Davis, president of The Commonwealth Fund. "Not only do we need better methods to identify and shut down illegal operations, we need to expand access to affordable coverage and reduce the demand that phony plans are exploiting."

Every state has laws making it illegal to operate an insurance company without a license. Unlicensed plans ignore state and federal insurance regulations, including solvency standards that ensure a company will be able to pay the claims of enrolled individuals.

In their report, Health Insurance Scams: How Government Is Responding and What Further Steps Are Needed, Mila Kofman, Kevin Lucia, and Eliza Bangit of Georgetown University's Health Policy Institute note that health insurance scams have been rising over the past two years as insurance premiums have increased at double-digit rates. Among their findings:

  • Since 2001, four unauthorized plans have left nearly 100,000 people with approximately $85 million in unpaid medical debts and without health coverage.
  • While no state is immune to the problem of unauthorized plans, some have been especially hard hit. In Florida nearly 30,000 victims of scams have been left uninsured and burdened with unpaid medical bills. The Texas Insurance Department has in the last

Contact: Mary Mahon
Commonwealth Fund

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