Fraud fear raised in California's health exchange

By Judy Lin

Associated Press

Published: Saturday, July 13 2013 1:00 p.m. MDT

Currently, Covered California's rules do not specify what offenses would disqualify an applicant for a counseling position. Lucero said the exchange is still reviewing its procedures and could follow other state employment guidelines.

Eric von Geldern, a deputy district attorney in Alameda County, said the exchange has adopted some good policies but can do more to protect consumers.

"We believe that a fingerprint and a background check are essential, along with an ongoing monitoring system, as opposed to just a qualifying requirement," said von Geldern, who also is president of NCFIA, a national anti-fraud organization based in Northern California. "We're working with Covered California to make sure those consumer protections are in place."

Covered California is expected to begin training and certifying enrollment counselors in August. They will be hired indirectly through an estimated 3,600 community organizations ranging from Native American tribes and chambers of commerce to labor unions and faith-based organizations that will be authorized to help people buy insurance.

The exchange will pay an organization $58 for each successful enrollment and $25 for a renewal, but the amount the counselors receive will vary.

Proponents of health reform view the consumer assistance program as an opportunity to enroll hard-to-reach residents, many of whom have just high school educations or less or speak a language other than English at home.

"We don't want applicants from communities where the exchange really needs to reach out to being sent away because they made a mistake in the past or bounced a rent check or have maybe a minor drug offense," said Cary Sanders, policy analysis director at the California Pan-Ethnic Health Network, a multicultural health organization. "It doesn't have a bearing on their ability to provide the appropriate assistance to their communities."

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