Around the PIA Western Alliance States – Week of February 19, 2024

Idaho — Bingham County agent sentenced for insurance fraud: The Idaho Department of Insurance (DOI) announced today that Scott Packham of Blackfoot, Idaho was sentenced in Bingham County for felony Misappropriation of Trust Funds.

In a plea agreement with prosecutors from the Idaho Attorney General’s Office, Packham plead guilty to one felony count of Diverting Fiduciary Insurance Funds under 41-1024(3), Idaho Code, and was sentenced on February 7, 2024.

Two of the victims attended the sentencing, one of whom gave an impact statement. The individual explained that they suffered a broken pipe and water damage in their home during the time when their insurance policy was terminated, due to Packham keeping the premium money. Fortunately, the insurance company reinstated the policy and honored the claim after the customer was able to prove they had paid the premium to Packham’s agency.

Packham was sentenced to three years prison (one year fixed and two years indeterminate). The judge suspended the sentence, and Packham was placed on two years of supervised probation. He must serve 100 hours of community service, and pay fines and restitution to the DOI, individual victims and insurance companies. The DOI revoked Packham’s insurance license in November 2020.

“Idaho Insurance Code exists to protect Idaho consumers, and agents are required to abide by it,” said Director Dean Cameron. “Misconduct by licensed agents is not tolerated by the Department.”

Washington — Third RFI for BBPA dispute resolution mechanism: On February 1, 2023, OIC released a request for information (RFI) for the Balance Billing Protection Act (BBPA) dispute resolution mechanism. OIC solicited comments as to whether, under the authority provided in RCW 48.49.040, Washington state should transition to the federal No Surprises Act Independent Dispute Resolution (NSA IDR) process on July 1, 2023 or continue to use the BBPA arbitration system to resolve disputes between carriers (or self-funded group health plans that have elected to participate in the BBPA) and nonparticipating providers.

On February 27, 2023, in response to comments received to the request for information, OIC announced that it would be delaying transition to the NSA IDR system for a minimum of six months.

On July 20, 2023, OIC released a second RFI related to the BBPA dispute resolution mechanism. OIC solicited comments as to whether, under the authority provided in RCW 48.49.040, Washington state should transition to the NSA IDR process on January 1, 2024 or continue to use the BBPA arbitration system to resolve disputes between carriers (or self-funded group health plans that have elected to participate in the BBPA) and nonparticipating providers. Comments were due August 4th, 2023.

On August 3, 2023, due to the ruling in Texas Medical Association, et al. v. United States Department of Health and Human Services the NSA IDR process was temporarily paused and was no longer accepting newly initiated disputes. It was reopened on December 15, 2023.

On September 1, 2023, in response to comments received during the RFI and the above ruling OIC announced it would be delaying transition to the NSA IDR system for a minimum of six months or July 1, 2024.

We are now releasing a third RFI related to the BBPA dispute resolution mechanism and soliciting comments as to whether Washington state should transition to the federal NSA IDR system on July 1, 2024, or continue to use the BBPA arbitration system to resolve disputes between carriers (or self-funded group health plans that have elected to participate in the BBPA) and nonparticipating providers. For more information on this RFI or the BBPA please visit our webpage on arbitration.

Comments on this RFI are due February 22, 2024; please send comments to Policy & Legislative Affairs. OIC will provide an update on this issue on or before March 1, 2024.

Washington — Renowned Washington state consumer program celebrates 45th anniversary: A small volunteer effort that started in Mount Vernon and grew into one of the nation’s most popular senior customer assistance programs is celebrating 45 years of work.

The Statewide Health Insurance Benefits Advisors (SHIBA) program, part of the Office of the Insurance Commissioner (OIC), has spent more than 40 years providing hundreds of thousands of Medicare beneficiaries in Washington state with free, unbiased and confidential counseling services.

SHIBA helps people in every corner of the state with questions about enrolling in Medicare, switching plans, getting prescription drug help and reporting Medicare fraud.

“People will stop to thank me for the SHIBA program and tell me how it has helped them or a loved one,” said Insurance Commissioner Mike Kreidler. “It saved some people money on their health insurance and it helped some people find the right health coverage. I’m incredibly proud of the work they’ve been doing for more than four decades to support seniors in our state.”

In 1976, a group of Mount Vernon volunteers acquired funding as part of a pilot program to help counsel senior citizens on health insurance, Medicare and Medicaid. The OIC noticed and Dick Marquardt — state insurance commissioner at the time — officially endorsed SHIBA in 1979, establishing the program as a statewide effort. 

SHIBA’s impact grew in the eyes of senior health advocates and consumers across the state. In 1990, it inspired the federal government to create the national State Health Insurance Assistance Programs. The federal program provides seniors with health insurance assistance in all 50 states plus Puerto Rico, Guam, the District of Columbia and the U.S. Virgin Islands.

“The people who choose to become a SHIBA volunteer find great meaning and satisfaction helping others in their community,” said Tim Smolen, SHIBA Program Director. “Many of the people who contact us are struggling to understand their Medicare options and feel overwhelmed. It’s empowering to our volunteers — who are also Medicare-age — to feel they made a difference in someone’s life. It’s a win for both parties.”

The OIC is hosting several SHIBA events across the state this year to recognize the journey over the last 45 years. This includes celebrating the current 250 dedicated volunteers and their organizations, who are at the heart of the program’s success.

Find out more information about SHIBA, its volunteer program and the anniversary celebration.

About SHIBA

The SHIBA program provides information on all the parts of Medicare, Medigap (Medicare Supplement) and Medicare Advantage plans, Medicaid programs, employment-related health benefits, long-term care options, fraud and abuse, and much more. We answer questions, make referrals, help evaluate and compare health insurance policies, make public presentations, and more. For people getting ready to enroll in Medicare or those already on Medicare who have questions, can call SHIBA at 800-562-6900 or contact us online.

About PIA Western Alliance

The Professional Insurance Agents Western Alliance is a membership organization promoting and enhancing the success of independent agencies seeking to grow, learn and be heard within the industry.


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