Case Notes - December 2024
Case: The Bureau of Investigation opened an investigative file on a health insurance agent after receiving a referral from the Centers for Medicare & Medicaid Services (CMS). CMS alleged the agent enrolled numerous individuals with ACA plans through the Federally Facilitated Marketplace (FFM) without their knowledge and consent.
Numerous consumers began noticing that they were enrolled in health insurance plans through the Federal Marketplace without their knowledge. In nearly all instances, the insureds were already covered through other plans. One insured was covered through Medicaid and did not need a Marketplace policy. The common thread was that the subject was the producing agent on all the fraudulent enrollments.
Investigators obtained statements from several victims, and extensive information about the transactions from insurance carriers and CMS.
Disposition: Suspended for 12 months.
Case: An investigation was opened on a general lines agent after another licensee reported the subject was "loaning" out her insurance license to an insurance agency for use by unlicensed individuals.
The complaint led to investigators determining a licensed insurance agent hired an unlicensed individual to work in its agency. The agency management allowed the agent to solicit clients for auto insurance business and complete applications. The subject would then sign the applications remotely because she never visited the agency and never met with the applicants. The subject was aiding and abetting the insurance agency in the sale of insurance by unlicensed employees of the agency.
Disposition: Fined $1,000 and suspended for 6 months. Cases are also being worked on the agent in charge and the agency owner.
Case: An investigation was opened on a public adjuster who failed to maintain the required surety bond. The public adjuster was contacted several times about the requirement, and that he had a limited time to submit an active bond or his license would become inactive. The time period to submit an active bond expired.
Disposition: License administratively surrendered. The subject cannot apply for another license for one year after the surrender and will be required to pass the public adjuster examination and satisfy all applicable required prior to consideration by the Department.
Case: An investigation was initiated against the agent in charge of an insurance agency after the Bureau received a complaint from an auto insurance company. The insurer alleged the life, health and general lines agent signed and submitted more than 100 automobile policy applications for consumers with "unknown" credit scores, by using the credit scores of other customers with high credit scores. While under his supervision, licensees working at the agency used the credit scores of multiple individuals to provide lower rates.
Disposition: The agent administratively surrendered his licenses and was barred from ever applying for any license type with the Department.
