Health Benefit Exchanges: False Claims Gold Mines?

Overview -

The Affordable Care Act enables the establishment of Health Benefit Exchanges of several types, including (i) State-based, (ii) State-Federal partnerships and (iii) Federally Facilitated Exchanges. The purpose of the Exchanges is to, among other things, ‘‘provide competitive marketplaces for individuals and small employers to directly compare available private health insurance on the basis of price, quality and other factors.

In theory, the information provided by the exchanges will ‘‘give small businesses the same purchasing clout as larger businesses.’’ Those goals are laudable and hard to quarrel with —anyone who has tried to buy individual health insurance knows that the available information on comparability of insurance plans is at best insufficient and at worst opaque.

Originally published in Health Care Fraud Report, BNA’s Health Care Fraud Report on 05/15/2013.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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