Tags: Health Topics | Healthcare Reform | obamacare | healthcare | government accountability office | fraud

Report: Lack of Follow Up Leading to Obamacare Fraud

Image: Report: Lack of Follow Up Leading to Obamacare Fraud
(Saul Loeb/AFP/Getty Images)

By    |   Wednesday, 24 Feb 2016 11:57 AM

The Obama administration isn't adequately tracking and analyzing information from Obamacare recipients, leaving the program vulnerable to fraud, according to a watchdog report.

The Government Accountability Office finds that in 2014, 431,000 Obamacare applicants who got about $1.7 billion in subsidies still had inconsistencies in their applications as of April 2015 — months after the coverage year had ended. 

Inconsistencies — when an applicant's information does not match federal databases — can occur around issues like a Social Security number or immigration status. The Centers for Medicare and Medicaid Services "did not have an effective process for resolving" them, the GAO report finds.

"With unresolved inconsistencies, CMS is at risk of granting eligibility to, and making subsidy payments on behalf of, individuals who are ineligible to enroll in qualified health plans," the report notes. "In addition, according to the Internal Revenue Service, accurate Social Security numbers are vital for income tax compliance and reconciliation of advance premium tax credits that can lower enrollee costs."

The report also found CMS hadn't taken enough steps to find out where there might be fraud vulnerabilities.

"CMS has not performed a comprehensive fraud risk assessment — a recommended best practice — of the [Obamacare] enrollment and eligibility process," the GAO states. "Until such an assessment is done, CMS is unlikely to know whether existing control activities are suitably designed and implemented to reduce inherent fraud risk to an acceptable level."

The Hill reports the Department of Health and Human ServicesI says it's already ended coverage for 471,000 people in 2015 who failed to produce enough documentation around their immigration status, and had adjusted subsidy amounts for over 1 million households.

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The Obama administration isn't adequately tracking and analyzing information from Obamacare recipients, leaving the program vulnerable to fraud, according to a watchdog report.
obamacare, healthcare, government accountability office, fraud
271
2016-57-24
Wednesday, 24 Feb 2016 11:57 AM
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