The federal agency in charge of HealthCare.gov is quietly preparing for the2018 open enrollment period — and responding tocomplaints that agents and brokers may have pushed someconsumers into 2017 health coverage without their permission.

The Center for Consumer Information and Insurance Oversight(CCIIO) talked about its procedures for handling sham enrollmentreports in a collection of slidedecks posted on a private technicalassistance website earlier this week.

Officials do not say how common the sham enrollment problem is,or whether they have any indications of sham enrollments coming inthrough distribution channels other than agents and brokers.

Here are some points of possible interest to agents andbrokers:

• The CCIIO team in charge of investigating the sham enrollmentcomplaints is the Center for Program Integrity.

• Ellen Witman is one of the health insurance specialists onteam.

• CCIIO wants any health coverage issuers asking for coverage"rescissions," or moves to annul coverage, as if the coverage hadnever existed in the first place, to give it the names and NationalProducer Numbers of any producers involved with coverage sales.

• CCIIO does not appear to be asking for the names of anyNavigators or other nonprofit exchange plan enrollment helpersinvolved with coverage problem enrollment allegations.

• Even though a coverage rescission and a cancellation of a shamenrollment may look similar, the regulations that govern thosetransactions are different. Only the coverage issuer can ask for arescission. The unwilling enrollee is the party who asks for thecancellation of the coverage resulting from a sham enrollment.

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CCIIO has developed a five-part test fordeciding whether a consumer might have a valid complaint about asham enrollment. One of the criteria is that the consumer cannothave filed any claims against the coverage. Another is that theconsumer cannot have had any direct communication with the coverageissuer until the consumer began the process of reporting theexistence of the unwanted coverage.

What's CCIIO?

Drafters of the Patient Protection and Affordable Care Act of2010 and the Health Care and Education Reconciliation Act of 2010,the bills that created the Affordable Care Act, put in the ACApublic health insurance exchange provisions in an effort to createa web-based supermarket for health insurance. The goal was to helpconsumers shop for health coverage from private issuers as easilyas they shop for airline tickets.

The ACA drafters thought each state would set up and run its ownexchange.

The U.S. Department of Health and Human Services createdHealthCare.gov to provide ACA public exchange account setup, planenrollment and account administration services for states that wereunable or unwilling to provide all of the services themselves.

The Centers for Medicare and Medicaid Services is the arm of HHSthat oversees HealthCare.gov.

CCIIO is the Centers for Medicare and Medicaid Services divisionthat runs HealthCare.gov and develops and enforces HealthCare.govrules. In official documents, it usually refers to HealthCare.govas "the Marketplace."

How sham enrollments can exist

HealthCare.gov offers Affordable Care Act subsidies that canreduce an enrollee's out-of-pocket costs to zero, or near zero.

CCIIO officials say some of the sham enrollments seem to involvesituations in which producers used real, or fake, information abouta consumer's finances to get the consumer very high subsidy levels,to reduce the consumer's share of the monthly premiums to zero.

In other cases, officials say, the unwilling enrollees may haveowed low monthly premium payments, and those payments were nevermade. The issuers canceled the coverage in those sham enrollmentcases after the unwilling enrollees failed to make any of theircoverage payments.

In a typical sham enrollment case, officials say, the unwillingenrollee learns about the coverage when the Internal RevenueService notices the gap between the consumer's actual income andthe income estimate given on the health insurance premium taxcredit application.