NBC News October 28, 2015
Obamacare Still Dealing with Fraud
Following more than one year of implementation, the ACA exchanges are experiencing fraud in the form of false social security numbers, bad immigration information and other forms of misrepresentation. Additionally, the Forensic and Investigative service of the GAO (Government Accountability Office) found instances of double insurance with enrollees being covered by Medicare and private payors.
The GAO set up a sting operation submitting false applications, wrong social security numbers, and other characteristics that should have been recognized by the software which were not. The false applications were actually accepted. To add to the disorganization, the plans that were approved were subsidized plans ultimately costing the tax payer.
HHS spokeswoman Meaghan Smith responded by indicating, “it seems unlikely that many uninsured Americans, many of whom have less than $100 in savings, would choose to commit perjury in order to pay the premiums and deductibles for two insurance policies or to pay premiums for marketplace insurance when eligible for Medicaid. In addition, the Affordable Care Act’s design reduces the incentive for individuals to lie on their application because financial assistance is paid directly to the issuer, so an individual cannot directly profit.”
The GAO said that HHS doesn’t have the appropriate checks and balances to make sure covered individuals had only one form of coverage either Medicare or private carrier.
Duplicate coverages under certain circumstances is permissible. However if a consumer was receiving subsidized coverage and is no longer eligible, such additional private coverage is not permissible.
Enter the political discussion. Republicans of both houses have and will continue to use this information to further their cause aimed at the repeal of the ACA or parts thereof. Throughout 2014 warnings of these fraudulent submissions and activities were offered with little or no improved software enhancements to eliminate or reduce these occurrences.
Responding once again the HHS said; “when we are provided with information that we can use to improve the Marketplace, we take action. That’s why we have repeatedly requested and remain disappointed to still not receive from the GAO specific details and recommendations relating to their fraudulent applications to enable us to analyze and understand what occurred and whether we can make improvements to our processes or procedures.”
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