Federal undercover investigation signs up fake applicants for ACA coverage, subsidies
Government investigators were able to procure health plans and federal subsidies for fake applicants. (Karen Bleier/AFP/Getty Images)
In
undercover tests of the new federal health insurance marketplace,
government investigators have been able to procure health plans and
federal subsidies for fake applicants with fictitious documents,
according to findings that will be disclosed to lawmakers Wednesday.
The
results of the inquiry by the Government Accountability Office are
evidence of still-imperfect work by specialists intended to assist new
insurance customers as well as government contractors hired to verify
that coverage and subsidies are legitimate. The GAO also pointed to
flaws that linger in the marketplace’s Web site, HealthCare.gov.
According
to testimony to be delivered before a House Ways and Means
subcommittee, undercover GAO investigators tried to obtain health plans
for a dozen fictitious applicants online or by phone, using invalid or
missing Social Security numbers or inaccurate citizenship information.
All
but one of the fake applicants ended up getting subsidized coverage —
and have kept it. In one instance, an application was denied but then
approved on a second try. In six other attempts to sign up fake
applicants via in-person assisters, just one assister accurately told an
investigator that the applicant’s income was too high for a subsidy.
In
their testimony, GAO officials plan to emphasize that the findings are
preliminary and that they are continuing the investigation before
reaching final conclusions, probably next year. The tests have been done
in several states. Because the work is not finished, the GAO is not
identifying the states.
California and Florida lead the way for state and federal healthcare sign-up markets.
House
Republicans were eager for early information because the findings
reinforce their contention that the Obama administration set up the
health insurance marketplace in ways that leave it vulnerable to fraud
and waste of taxpayer money. The allegation that HealthCare.gov does not
properly verify the identity and eligibility of consumers has been one
of several lines of attack that congressional Republicans have used in
trying to discredit the 2010 Affordable Care Act and the way
administration officials set it in motion.
The
GAO investigation was requested before the marketplace opened in the
fall, by House Ways and Means Chairman Dave Camp (R-Mich.); Rep. Charles
W. Boustany Jr. (R-La.), chairman of the Ways and Means oversight
subcommittee; and Sens. Tom Coburn (R-Okla.) and Orrin G. Hatch
(R-Utah).
Even before the GAO delivered
the early findings, the lawmakers were seizing them as fresh ammunition.
“We are seeing a trend with Obamacare information systems: under every
rock, there is incompetence, waste and the potential for fraud,” Camp
said in a statement. “Now, we learn that in many cases, the exchange is
unable to screen out fake identities or documents.”
A
spokesman for the federal agency that oversees the marketplace, the
Department of Health and Human Services’ Centers for Medicare and
Medicaid Services, noted that the procedures for ensuring that the
applicants’ information is accurate remain a work in progress. “We . . .
will work with GAO to identify additional strategies to strengthen our
verification processes during this first year of the Affordable Care
Act,” CMS spokesman Aaron Albright said.
The
GAO’s account of fictitious applicants obtaining subsidized coverage
goes beyond a related problem that surfaced this spring and that the
investigators also cited: The government may be paying incorrect
insurance subsidies to a significant share of the 5.4 million Americans
who signed up for health plans for this year through the federal
marketplace.
The GAO testimony contains
updates on that problem, saying that, as of mid-July, about 2.6 million
“inconsistencies” existed among applicants who had chosen a health plan
and that 650,000 of them had been resolved.
No comments:
Post a Comment