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Emma Wilson

What happens if someone falsified health insurance information on their tax return?

So I've got this situation with a friend who I think might be in some hot water with the IRS. From what she told me, she missed the enrollment period for both the marketplace and her boyfriend's employer insurance. As a result, two of her kids didn't have any health insurance coverage for the entire year (at least that's what she believes). She had another baby in mid-September. Both she and her boyfriend are covered through her dad's insurance plan. Now she's freaking out because her tax return hasn't been approved after 3 days, and she's convinced they've caught the discrepancy. She's talking about calling the IRS to... honestly I'm not sure what her plan is. Come clean? Try to explain? I don't know enough about tax implications of misreporting health insurance to give her advice. What kind of trouble could she be in if she did lie about her kids having health insurance? And what would be the best course of action for her right now? Should she just wait it out or proactively contact someone?

Malik Thomas

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Three days is nothing to worry about for tax return processing. The IRS is often backed up and returns can take weeks or even months to process, especially if there are any complexity factors. That said, misrepresenting information on a tax return is never a good idea. The shared responsibility payment (the "penalty" for not having health insurance) was reduced to $0 starting in 2019 at the federal level, so there's no federal penalty for not having coverage. However, some states still have their own individual mandates and penalties. The bigger issue is that she knowingly provided false information on a document signed under penalty of perjury. The IRS may not catch it immediately, but they can audit returns for up to 3 years after filing (and longer in some cases). My advice would be to file an amended return with the correct information. It's always better to correct mistakes proactively rather than waiting for the IRS to discover them.

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If the shared responsibility payment is $0, why would she need to amend? Wouldn't that just draw attention to the situation for no benefit? Also, do you know if the marketplace offers any special enrollment periods for having a baby? Since she had one in September, maybe there's a way to get retroactive coverage?

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Malik Thomas

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The federal penalty is indeed $0, but several states including California, Massachusetts, New Jersey, Rhode Island, and DC have their own mandates with penalties. Without knowing which state she's in, I can't say if she faces state penalties. Yes, having a baby qualifies as a Special Enrollment Period event, allowing enrollment outside the standard window. She would have had 60 days after the birth to enroll in coverage. This wouldn't help with the period before the birth, but could have provided coverage for the newborn and potentially the other children going forward.

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Ravi Kapoor

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I was in a similar situation last year with confusing health insurance documentation, and I found the tools at https://taxr.ai incredibly helpful. I was worried about mistakes on my return because my insurance situation changed mid-year when I switched jobs. The software analyzed my tax documents and flagged inconsistencies between what my previous employer reported and what I had entered. It saved me from potentially misreporting my coverage periods. The system is really user-friendly - I just uploaded my tax documents and it highlighted discrepancies I needed to address before submission.

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Freya Larsen

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Does this tool actually communicate with the IRS database to verify information? Or does it just compare documents that you provide? My situation is complicated with coverage gaps throughout the year.

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I'm interested but skeptical. How would this help if someone has already submitted their return with incorrect info? Wouldn't they need something to help with amending the return instead?

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Ravi Kapoor

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It doesn't communicate directly with the IRS database - it analyzes the documents you upload to identify discrepancies or potential issues between various forms and what you're reporting on your return. This helps catch mistakes before submission or helps you understand what might need correction on an amended return. For amending returns, it can be even more valuable because it helps identify exactly what information needs to be corrected, making the amendment process more straightforward and accurate. It analyzes all your relevant tax forms together to spot inconsistencies that might trigger further IRS scrutiny.

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I was really skeptical about taxr.ai at first, but after using it to review my submitted return (which had health insurance reporting issues similar to what your friend is dealing with), I'm glad I tried it. It flagged exactly where my reporting was inconsistent with my 1095 forms. The analysis showed me precisely what I needed to correct on my amended return. Instead of guessing what might have triggered the IRS delay, I had clear guidance on the specific discrepancies. The peace of mind alone was worth it, and the amendment process went smoothly because I knew exactly what needed fixing.

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Omar Zaki

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If your friend is worried about the IRS having questions, she might want to be proactive. I had a similar issue and spent WEEKS trying to get through to someone at the IRS. Finally used https://claimyr.com and it was a game-changer. They held my place in the phone queue and called me when an actual human at the IRS was available. You can see how it works here: https://youtu.be/_kiP6q8DX5c Instead of waiting on hold for hours or calling repeatedly and getting disconnected, I got through to a real person who explained my options. The agent walked me through exactly what I needed to do to correct my health insurance reporting mistake.

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Chloe Taylor

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How does this service actually work? Do they have some special access to the IRS or something? I've been trying to reach someone about my tax situation for days.

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Diego Flores

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Yeah right. This sounds like some scam that just wants to charge people who are desperate to talk to the IRS. I seriously doubt this actually works any better than just calling yourself and waiting.

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Omar Zaki

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It uses an automated system that navigates the IRS phone tree and stays on hold for you. They don't have special IRS access - they just handle the waiting part, then call you when they reach a live person. You're connected directly to the IRS agent, so it's secure. I was skeptical too before trying it. I had spent almost 4 hours across multiple calls trying to get through myself. With Claimyr, I was connected in about 75 minutes (while I went about my day) and resolved my issue in a single call. They don't have access to your conversation - they just connect you.

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Diego Flores

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I need to apologize for my skeptical comment earlier. After my fifth attempt trying to reach the IRS about my own tax issue (kept getting disconnected after 40+ minutes on hold), I broke down and tried Claimyr. I'm genuinely shocked at how well it worked. Got connected to an IRS rep in about 90 minutes without having to sit by my phone. The agent was actually super helpful about my health insurance reporting issue. They explained that I qualified for an exemption I didn't know about and walked me through filing an amended return. Saved me a potential penalty and hours of frustration.

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Important to note - your friend should be careful about what she says if she does call the IRS. They record calls and anything she admits to could potentially be used if they decide to pursue penalties for knowingly providing false information. The penalty for filing a fraudulent return can be up to 75% of the underpayment, plus potentially criminal charges in serious cases (though that's rare for something like this). She should consider consulting with a tax professional before making any calls.

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Emma Wilson

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Do you think this rises to the level of actual fraud though? I mean, she did provide incorrect information, but is misreporting health insurance coverage really something they prosecute for? I'm trying to gauge how serious this is.

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It likely wouldn't rise to the level of criminal prosecution unless there were other serious issues with the return. The key distinction is between a mistake and willful misrepresentation. If she knowingly provided false information, that technically constitutes fraud, even if the direct financial impact is minimal. That said, for just health insurance misreporting without tax impact, the practical risk is relatively low. The IRS has limited resources and focuses enforcement on cases with significant revenue impact. Still, the safest approach is filing an amended return with the correct information to avoid any potential issues.

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Sean Murphy

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One thing nobody's mentioned - if her return is just delayed, it might have nothing to do with the health insurance issue at all. My return took 11 weeks to process last year because of a backlog. The IRS is STILL catching up from the pandemic and staffing issues. Not every delay means they found a problem. Sometimes it's just the system being slow. And even if they do flag something, they usually send a letter asking for clarification before assuming fraud.

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StarStrider

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That's a really good point. I had a completely accurate return last year that took over 8 weeks, and I got no explanation. My friend filed the same week and got his refund in 10 days. The systems seem pretty random sometimes.

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