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As open enrollment for Affordable Care Act plans continues through Jan. 15, you’re likely seeing fewer social media ads promising monthly cash cards worth hundreds, if not thousands, of dollars that you can use for groceries, medical bills, rent and other expenses. But don’t worry. You haven’t missed out on any windfalls. Clicking on one of those ads would not have provided you with a cash card — at least not worth hundreds or thousands. But you might have found yourself switched to a health insurance plan you did not authorize, unable to afford treatment for an unforeseen medical emergency, and owing thousands of dollars to the IRS, according to an ongoing lawsuit against companies and individuals who plaintiffs say masterminded the ads and alleged scams committed against millions of people who responded to them. The absence of those once-ubiquitous ads are likely a result of the federal government suspending access to the ACA marketplace for two companies that market health insurance out of South Florida offices, amid accusations they used “fraudulent” ads to lure customers and then switched their insurance plans and agents without their knowledge. In its suspension letter, the Centers for Medicare & Medicaid Services (CMS) cited “credible allegations of misconduct” in the agency’s decision to suspend the abilities of two companies — TrueCoverage (doing business as Inshura) and BenefitAlign — to transact information with the marketplace. CMS licenses and monitors agencies that use their own websites and information technology platforms to enroll health insurance customers in ACA plans offered in the federal marketplace. The alleged scheme affected millions of consumers, according to a lawsuit winding its way through U.S. District Court in Fort Lauderdale that seeks class-action status. An amended version of the suit, filed in August, increased the number of defendants from six to 12: — TrueCoverage LLC, an Albuquerque, New Mexico-based health insurance agency with large offices in Miami, Miramar and Deerfield Beach. TrueCoverage is a sub-tenant of the South Florida Sun Sentinel in a building leased by the newspaper in Deerfield Beach. — Enhance Health LLC, a Sunrise-based health insurance agency that the lawsuit says was founded by Matthew Herman, also named as a defendant, with a $150 million investment from hedge fund Bain Capital’s insurance division. Bain Capital Insurance Fund LP is also a defendant. — Speridian Technologies LLC, accused in the lawsuit of establishing two direct enrollment platforms that provided TrueCoverage and other agencies access to the ACA marketplace. — Benefitalign LLC, identified in the suit as one of the direct enrollment platforms created by Speridian. Like Speridian and TrueCoverage, the company is based in Albuquerque, New Mexico. — Number One Prospecting LLC, doing business as Minerva Marketing, based in Fort Lauderdale, and its founder, Brandon Bowsky, accused of developing the social media ads that drove customers — or “leads” — to the health insurance agencies. — Digital Media Solutions LLC, doing business as Protect Health, a Miami-based agency that the suit says bought Minerva’s “fraudulent” ads. In September, the company filed for Chapter 11 protection from creditors in United States Bankruptcy Court in Texas, which automatically suspended claims filed against the company. — Net Health Affiliates Inc., an Aventura-based agency the lawsuit says was associated with Enhance Health and like it, bought leads from Minerva. — Garish Panicker, identified in the lawsuit as half-owner of Speridian Global Holdings and day-to-day controller of companies under its umbrella, including TrueCoverage, Benefitalign and Speridian Technologies. — Matthew Goldfuss, accused by the suit of overseeing and directing TrueCoverage’s ACA enrollment efforts. All of the defendants have filed motions to dismiss the lawsuit. The motions deny the allegations and argue that the plaintiffs failed to properly state their claims and lack the standing to file the complaints. The Sun Sentinel sent requests for comment and lists of questions about the cases to four separate law firms representing separate groups of defendants. Three of the law firms — one representing Brandon Bowsky and Number One Prospecting LLC d/b/a Minerva Marketing, and two others representing Net Health Affiliates Inc. and Bain Capital Insurance Fund — did not respond to the requests. A representative of Enhance Health LLC and Matthew Herman, Olga M. Vieira of the Miami-based firm Quinn Emanuel Urquhart & Sullivan LLP, responded with a short message saying she was glad the newspaper knew a motion to dismiss the charges had been filed by the defendants. She also said that, “Enhance has denied all the allegations as reported previously in the media.” Catherine Riedel, a communications specialist representing TrueCoverage LLC, Benefitalign LLC, Speridian Technologies LLC, Girish Panicker and Matthew Goldfuss, issued the following statement: “TrueCoverage takes these allegations very seriously and is responding appropriately. While we cannot comment on ongoing litigation, we strongly believe that the allegations are baseless and without merit. “Compliance is our business. The TrueCoverage team records and reviews every call with a customer, including during Open Enrollment when roughly 500 agents handle nearly 30,000 calls a day. No customer is enrolled into any policy without a formal verbal consent given by the customer. If any customer calls in as a result of misleading content presented by third-party marketing vendors, agents are trained to correct such misinformation and action is taken against such third-party vendors.” Through Riedel, the defendants declined to answer follow-up questions, including whether the company remains in business, whether it continues to enroll Affordable Care Act clients, and whether it is still operating its New Mexico call center using another affiliated technology platform. The suspension notification from the Centers for Medicare and Medicaid Services letter cites several factors, including the histories of noncompliance and previous suspensions. The letter noted suspicion that TrueCoverage and Benefitalign were storing consumers’ personally identifiable information in databases located in India and possibly other overseas locations in violation of the centers’ rules. The letter also notes allegations against the companies in the pending lawsuit that “they engaged in a variety of illegal practices, including violations of the (Racketeer Influenced & Corrupt Organizations, or RICO Act), misuse of consumer (personal identifiable information) and insurance fraud.” The amended lawsuit filed in August names as plaintiffs five individuals who say their insurance plans were changed and two agencies who say they lost money when they were replaced as agents. The lawsuit accuses the defendants of 55 counts of wrongdoing, ranging from running ads offering thousands of dollars in cash that they knew would never be provided directly to consumers, switching millions of consumers into different insurance policies without their authorization, misstating their household incomes to make them eligible for $0 premium coverage, and “stealing” commissions by switching the agents listed in their accounts. TrueCoverage, Enhance Health, Protect Health, and some of their associates “engaged in hundreds of thousands of agent-of-record swaps to steal other agents’ commissions,” the suit states. “Using the Benefitalign and Inshura platforms, they created large spreadsheet lists of consumer names, dates of birth and zip codes.” They provided those spreadsheets to agents, it says, and instructed them to access platforms linked to the ACA marketplace and change the customers’ agents of record “without telling the client or providing informed consent.” “In doing so, they immediately captured the monthly commissions of agents ... who had originally worked with the consumers directly to sign them up,” the lawsuit asserts. TrueCoverage employees who complained about dealing with prospects who called looking for cash cards were routinely chided by supervisors who told them to be vague and keep making money, the suit says. When the Centers for Medicare and Medicaid Services began contacting the company in January about customer complaints, the suit says TrueCoverage enrollment supervisor Matthew Goldfuss sent an email instructing agents “do not respond.” The lawsuit states the “scheme” was made possible in 2021 when Congress passed the American Rescue Plan Act in the wake of the COVID pandemic. The act made it possible for Americans with household incomes between 100% and 150% of the federal poverty level to pay zero in premiums and it enabled those consumers to enroll in ACA plans all year round, instead of during the three-month open enrollment period from November to January. Experienced health insurance brokers recognized the opportunity presented by the changes, the lawsuit says. More than 40 million Americans live within 100% and 150% of the federal poverty level, while only 15 million had ACA insurance at the time. The defendants developed or benefited from online ads, the lawsuit says, which falsely promised “hundreds and sometimes thousands of dollars per month in cash benefits such as subsidy cards to pay for common expenses like rent, groceries, and gas.” Consumers who clicked on the ads were brought to a landing page that asked a few qualifying questions, and if their answers suggested that they might qualify for a low-cost or no-cost plan, they were provided a phone number to a health insurance agency. There was a major problem with the plan, according to the lawsuit. “Customers believe they are being routed to someone who will send them a free cash card, not enroll them in health insurance.” By law, the federal government sends subsidies for ACA plans to insurance companies, and not to individual consumers. Scripts were developed requiring agents not to mention a cash card, and if a customer mentions a cash card, “be vague” and tell the caller that only the insurance carrier can provide that information, the lawsuit alleges. In September, the defendants filed a motion to dismiss the claims. In addition to denying the charges, they argued that the class plaintiffs lacked the standing to make the accusations and failed to demonstrate that they suffered harm. The motion also argued that the lawsuit’s accusations failed to meet requirements necessary to claim civil violations of the RICO Act. Miami-based attorney Jason Kellogg, representing the plaintiffs, said he doesn’t expect a ruling on the motion to dismiss the case for several months. The complaint also lists nearly 50 companies, not named as defendants, that it says fed business to TrueCoverage and Enhance Health. Known in the industry as “downlines,” most operate in office parks throughout South Florida, the lawsuit says. The lawsuit quotes former TrueCoverage employees complaining about having to work with customers lured by false cash promises in the online ads. A former employee who worked in the company’s Deerfield Beach office was quoted in the lawsuit as saying that senior TrueCoverage and Speridian executives “knew that consumers were calling in response to the false advertisements promising cash cards and they pressured agents to use them to enroll consumers into ACA plans.” A former human resources manager for TrueCoverage said sales agents frequently complained “that they did not feel comfortable having to mislead consumers,” the lawsuit said. Over two dozen agents “came to me with these complaints and showed me the false advertisements that consumers who called in were showing them,” the lawsuit quoted the former manager as saying. For much of the time the companies operated, the ACA marketplace enabled agents to easily access customer accounts using their names and Social Security numbers, change their insurance plans and switch their agents of record without their knowledge or authorization, the lawsuit says. This resulted in customers’ original agents losing their commissions and many of the policyholders finding out they suddenly owed far more for health care services than their original plans had required, the suit states. It says that one of the co-plaintiffs’ health plans was changed at least 22 times without her consent. She first discovered that she had lost her original plan when she sought to renew a prescription for her heart condition and her doctor told her she did not have health insurance, the suit states. Another co-plaintiff’s policy was switched after her husband responded to one of the cash card advertisements, the lawsuit says. That couple’s insurance plan was switched multiple times after a TrueCoverage agent excluded the wife’s income from an application so the couple would qualify. Later, they received bills from the IRS for $4,300 to cover tax credits issued to pay for the plans. CMS barred TrueCoverage and BenefitAlign from accessing the ACA marketplace. It said it received more than 90,000 complaints about unauthorized plan switches and more than 183,500 complaints about unauthorized enrollments, but the agency did not attribute all of the complaints to activities by the two companies. In addition, CMS restricted all agents’ abilities to alter policyholders’ enrollment information, the lawsuit says. Now access is allowed only for agents that already represent policyholders or if the policyholder participates in a three-way call with an agent and a marketplace employee. Between June and October, the agency barred 850 agents and brokers from accessing the marketplace “for reasonable suspicion of fraudulent or abusive conduct related to unauthorized enrollments or unauthorized plan switches,” according to an October CMS news release . The changes resulted in a “dramatic and sustained drop” in unauthorized activity, including a nearly 70% decrease in plan changes associated with an agent or broker and a nearly 90% decrease in changes to agent or broker commission information, the release said. It added that while consumers were often unaware of such changes, the opportunity to make them provided “significant financial incentive for non-compliant agents and brokers.” But CMS’ restrictions might be having unintended consequences for law-abiding agents and brokers. A story published by Insurance News Net on Nov. 11 quoted the president of the Health Agents for America (HAFA) trade group as saying agents are being suspended by CMS after being flagged by a mysterious algorithm that no one can figure out. The story quotes HAFA president Ronnell Nolan as surmising, “maybe they wrote too many policies on the same day for people who have the same income or they’re writing too many policies on people of a certain occupation.” Nolan continued, “We have members who have thousands of ACA clients. They can’t update or renew their clients. So those consumers have lost access to their professional agent, which is simply unfair.” Ron Hurtibise covers business and consumer issues for the South Florida Sun Sentinel. He can be reached by phone at 954-356-4071, on Twitter @ronhurtibise or by email at rhurtibise@sunsentinel.com.Sister of Quebec man killed in Florida boat explosion also injured, friend says
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BOGOTA, Colombia (AP) — 2024 was a brutal year for the Amazon rainforest, with rampant wildfires and extreme drought ravaging large parts of a biome that’s a critical counterweight to climate change. A warming climate fed drought that in turn fed the worst year for fires since 2005. And those fires contributed to deforestation, with authorities suspecting some fires were set to more easily clear land to run cattle. The Amazon is twice the size of India and sprawls across eight countries and one territory, storing vast amounts of carbon dioxide that would otherwise warm the planet. It has about 20% of the world’s fresh water and astounding biodiversity, including 16,000 known tree species. But governments have historically viewed it as an area to be exploited, with little regard for sustainability or the rights of its Indigenous peoples, and experts say exploitation by individuals and organized crime is rising at alarming rates. “The fires and drought experienced in 2024 across the Amazon rainforest could be ominous indicators that we are reaching the long-feared ecological tipping point,” said Andrew Miller, advocacy director at Amazon Watch, an organization that works to protect the rainforest. “Humanity’s window of opportunity to reverse this trend is shrinking, but still open.” There were some bright spots. The level of Amazonian forest loss fell in both Brazil and Colombia. And nations gathered for the annual United Nations conference on biodiversity agreed to give Indigenous peoples more say in nature conservation decisions. “If the Amazon rainforest is to avoid the tipping point, Indigenous people will have been a determinant factor," Miller said. Forest loss in Brazil’s Amazon — home to the largest swath of this rainforest — dropped 30.6% compared to the previous year, the lowest level of destruction in nine years. The improvement under leftist President Luiz Inácio Lula da Silva contrasted with deforestation that hit a 15-year high under Lula's predecessor, far-right leader Jair Bolsonaro, who prioritized agribusiness expansion over forest protection and weakened environmental agencies. In July, Colombia reported historic lows in deforestation in 2023, driven by a drop in environmental destruction. The country's environment minister Susana Muhamad warned that 2024's figures may not be as promising as a significant rise in deforestation had already been recorded by July due to dry weather caused by El Nino, a weather phenomenon that warms the central Pacific. Illegal economies continue to drive deforestation in the Andean nation. “It’s impossible to overlook the threat posed by organized crime and the economies they control to Amazon conservation,” said Bram Ebus, a consultant for Crisis Group in Latin America. “Illegal gold mining is expanding rapidly, driven by soaring global prices, and the revenues of illicit economies often surpass state budgets allocated to combat them.” In Brazil, large swaths of the rainforest were draped in smoke in August from fires raging across the Amazon, Cerrado savannah, Pantanal wetland and the state of Sao Paulo. Fires are traditionally used for deforestation and for managing pastures, and those man-made blazes were largely responsible for igniting the wildfires. For a second year, the Amazon River fell to desperate lows , leading some countries to declare a state of emergency and distribute food and water to struggling residents. The situation was most critical in Brazil, where one of the Amazon River's main tributaries dropped to its lowest level ever recorded. Cesar Ipenza, an environmental lawyer who lives in the heart of the Peruvian Amazon, said he believes people are becoming increasingly aware of the Amazon's fundamental role “for the survival of society as a whole." But, like Miller, he worries about a “point of no return of Amazon destruction.” It was the worst year for Amazon fires since 2005, according to nonprofit Rainforest Foundation US. Between January and October, an area larger than the state of Iowa — 37.42 million acres, or about 15.1 million hectares of Brazil’s Amazon — burned. Bolivia had a record number of fires in the first ten months of the year. “Forest fires have become a constant, especially in the summer months and require particular attention from the authorities who don't how to deal with or respond to them,” Ipenza said. Venezuela, Colombia, Ecuador, and Guyana also saw a surge in fires this year. The United Nations conference on biodiversity — this year known as COP16 — was hosted by Colombia. The meetings put the Amazon in the spotlight and a historic agreement was made to give Indigenous groups more of a voice on nature conservation decisions , a development that builds on a growing movement to recognize Indigenous people's role in protecting land and combating climate change. Both Ebus and Miller saw promise in the appointment of Martin von Hildebrand as the new secretary general for the Amazon Treaty Cooperation Organization, announced during COP16. “As an expert on Amazon communities, he will need to align governments for joint conservation efforts. If the political will is there, international backers will step forward to finance new strategies to protect the world’s largest tropical rainforest,” Ebus said. Ebus said Amazon countries need to cooperate more, whether in law enforcement, deploying joint emergency teams to combat forest fires, or providing health care in remote Amazon borderlands. But they need help from the wider world, he said. “The well-being of the Amazon is a shared global responsibility, as consumer demand worldwide fuels the trade in commodities that finance violence and environmental destruction,” he said. Next year marks a critical moment for the Amazon, as Belém do Pará in northern Brazil hosts the first United Nations COP in the region that will focus on climate. “Leaders from Amazon countries have a chance to showcase strategies and demand tangible support," Ebus said. The Associated Press’ climate and environmental coverage receives financial support from multiple private foundations. AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org .NEW YORK (AP) — The huge rally for U.S. stocks lost momentum on Thursday as Wall Street counted down to a big jobs report that’s coming on Friday. The crypto market had more action, and bitcoin briefly burst to a record above $103,000 before pulling back. The S&P 500 slipped 0.2% from the all-time high it had set the day before, its 56th of the year so far, to shave a bit off what’s set to be one of its best years of the millennium . The Dow Jones Industrial Average fell 248 points, or 0.6%, while the Nasdaq composite slipped 0.2% from its own record set the day before. Bitcoin powered above $100,000 for the first time the night before, after President-elect Donald Trump chose Paul Atkins, who's seen as a crypto advocate, as his nominee to head the Securities and Exchange Commission. The cryptocurrency has climbed dramatically from less than $70,000 on Election Day, but it fell back as Thursday progressed toward $99,000, according to CoinDesk. Sharp swings for bitcoin are nothing new, and they took stocks of companies enmeshed in the crypto world on a similar ride. After rising as much as 9% in early trading, MicroStrategy, a company that’s been raising cash just to buy bitcoin, swung to a loss of 4.8%. Crypto exchange Coinbase Global fell 3.1% after likewise erasing a big early gain. Elsewhere on Wall Street, stocks of airlines helped lead the way following the latest bumps up to financial forecasts from carriers. American Airlines Group soared 16.8% after saying it’s making more in revenue during the last three months of 2024 than it expected, and it will likely make a bigger profit than it had earlier forecast. The airline also chose Citi to be its exclusive partner for credit cards that give miles in its loyalty program. That should help its cash coming in from co-branded credit card and other partners grow by about 10% annually. Southwest Airlines climbed 2% after saying it’s seeing stronger demand from leisure travelers than it expected. It also raised its forecast for revenue for the holiday traveling season. On the losing end of Wall Street was Synposys, which tumbled 12.4%. The supplier for the semiconductor industry reported better profit for the latest quarter than analysts expected, but it also warned of “continued macro uncertainties” and gave a forecast for revenue in the current quarter that fell short of some analysts’ estimates. American Eagle Outfitters fell even more, 14.3%, after the retailer said it’s preparing for “potential choppiness” outside of peak selling periods. It was reminiscent of a warning from Foot Locker earlier in the week and raised more concerns about how resilient U.S. shoppers can remain. Solid spending by U.S. consumers has been one of the main reasons the U.S. economy has avoided a recession that earlier seemed inevitable after the Federal Reserve hiked interest rates to crush inflation. But shoppers are now contending with still-high prices and a slowing job market . Story continues below video This week’s highlight for Wall Street will be Friday’s jobs report from the U.S. government, which will show how many people employers hired and fired last month. A report on Thursday said the number of U.S. workers applying for unemployment benefits rose last week but remains at historically healthy levels. Expectations are high that the Fed will cut its main interest rate again when it meets in two weeks. The Fed began easing its main interest rate from a two-decade high in September, hoping to offer more support for the job market. In the bond market, the yield on the 10-year Treasury edged down to 4.17% from 4.18% late Wednesday. The S&P 500 fell 11.38 points to 6,075.11. The Dow sank 248.33 to 44,765.71, and the Nasdaq composite lost 34.86 to 19,700.26. In stock markets abroad, indexes were mostly calm in Europe after far-right and left-wing lawmakers in France joined together to vote on a no-confidence motion that will force Prime Minister Michel Barnier and his Cabinet to resign. The CAC 40 index in Paris added 0.4%. In South Korea, the Kospi fell 0.9% to compound its 1.4% decline from the day before. President Yoon Suk Yeol was facing possible impeachment after he suddenly declared martial law on Tuesday night. He revoked the martial law declaration six hours later. Crude oil prices slipped after eight members of the OPEC+ alliance of oil exporting countries decided to put off increasing oil production. AP Business Writers Yuri Kageyama and Matt Ott contributed.So you're gathering with relatives whose politics are different. Here are some tips for the holidays
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