Fraudulent Health Insurance Sales Practices in Pennsylvania

This case study explores a situation where a licensed health insurance broker in Pennsylvania is under investigation for alleged fraudulent sales practices.

ByExpert Institute

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Published on February 6, 2024

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Case Overview

This case study delves into the complex world of health insurance brokerage, focusing on a licensed broker operating in Pennsylvania and other states through various licensed agents.

The broker is currently under scrutiny by government authorities for alleged fraudulent sales practices. Their business model involves sourcing internet leads from potential consumers seeking alternatives to the Obamacare marketplace for their health insurance needs. These leads are then contacted following several verification protocols. Although the brokerage aspect of the sales has been conducted appropriately, there may have been negligence on the part of the insurance carriers or third-party administrators.

To refute these allegations, an expert with a deep understanding of health insurance brokerage and compliance is required to review the claims. In addition, an expert must conduct an internal audit of the company’s operations.

Questions to the expert and their responses

Q1

Please describe your experience in health insurance brokerage, specifically, compliance.

I have dedicated 20 years to the health insurance industry, working with multiple national and regional carriers in various roles in sales and management.

My experience includes collaborating with the Department of Insurance for numerous states while launching regional health plans for a Third-Party Administrator (TPA). Currently, I operate as an independent broker licensed by different national and regional carriers.

Additionally, I served as president of a state Association of Health Underwriters where I led the insurance brokers association.

Q2

What standards or protocols exist for brokering health insurance to new clients from internet leads?

There are specific laws surrounding health plan marketing, which vary by state. However, it’s imperative to note that you can market through paid leads. Unless further context is provided, this act seems compliant.

About the expert

This expert brings over a decade of experience in the insurance industry, with an educational background in economics and entrepreneurial studies from Rutgers University and Penn State University respectively. They have held significant roles such as business project specialist at a major healthcare company, manager of sales operations at a health service corporation, assistant vice president of business development at a healthcare management organization, and vice president of national sales at a health technology company. Currently, they serve as a partner at an insurance brokerage firm and are licensed to provide insurance throughout the country.

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