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The Patient Protection and Affordable Care Act (PPACA) requires applicant information be verified to determine eligibility for enrollment or income-based subsidies. To implement this verification process, the Centers for Medicare & Medicaid Services (CMS) created an electronic system called the “data services hub” (data hub), which, among other things, provides a single link to federal sources, such as the Internal Revenue Service and the Social Security Administration, to verify consumer application information.
So all applicants are to be verified. What happened?
For example, according to GAO analysis of CMS data, about 431,000 applications from the 2014 enrollment period, with about $1.7 billion in associated subsidies for 2014, still had unresolved inconsistencies as of April 2015—several months after close of the coverage year. In addition, CMS did not resolve Social Security number inconsistencies for about 35,000 applications (with about $154 million in associated subsidies) or incarceration inconsistencies for about 22,000 applications (with about $68 million in associated subsidies).
Almost $2 billion dollars in claims are unresolved from about 500,000 possible fraudulent claims - from general fraud claims, social security number fraud, and people who are in jail.
During undercover testing, the federal Marketplace approved subsidized coverage under the act for 11 of 12 fictitious GAO phone or online applicants for 2014. The GAO applicants obtained a total of about $30,000 in annual advance premium tax credits, plus eligibility for lower costs at time of service.
Fraudulent claims were accepted at above a 90% rate.
So the GAO is strongly suggesting that they get a grip on the fraud.
I think the government is OK with the fraud, in that it does boost the participation number. The illegal immigrants are probably benefiting as well.
You wonder why medical costs continue to rise, the people who pay the taxes are underwriting all of the fraud, and all of the government waste, as well as the people who are receiving "free" health care.
If people are interested in REAL affordable health care, get the government out of the revenue stream and let people who intend to provide real services do the work.
If the people need to overturn something, it takes awhile with this many people... especially with a portion of the people benefiting from this bad policy.
Just have to keep hammering away little by little.
The amount of fraud in Obamacare is pretty amazing.... You could actually create a fictitious person and they would never know and renew the plan every year.. Bottom line, any person could enroll, even Mickey Mouse...
The amount of fraud in Obamacare is pretty amazing.... You could actually create a fictitious person and they would never know and renew the plan every year.. Bottom line, any person could enroll, even Mickey Mouse...
“HHS approved the failed CO-OPs despite receiving specific warnings from a third-party analyst about weaknesses in their business plans,” the report states. Deloitte Consulting warned HHS of “several significant weaknesses” in the co-op proposals. In seven of the twelve failed co-ops, Deloitte noted enrollment strategies with defects including “inadequate actuarial analysis, to unsupported assumptions about sustainable premiums, [and] a lack of demonstrated understanding of the health demographics of the COOP’s target population.” Ten of the twelve failed co-ops had incomplete budget proposals flagged by Deloitte, and one even noted that their plan had a “stated target profit margin [of] zero.” Deloitte also raised concerns about leadership in all twelve failed co-ops.
The amount of fraud in Obamacare is pretty amazing.... You could actually create a fictitious person and they would never know and renew the plan every year.. Bottom line, any person could enroll, even Mickey Mouse...
I'd wager it's even higher than the GAO reported.
Don't worry though. When HHS is called to testify to Congress they will tell Congress they'll fix it.
That's what the FCC did with the free lifeline program. They never vetted the applicants.
Some had 2-3-4 plans with various telecoms. 60% got kicked out because they did not supply verification of income after the audit.
And now we're saving over $1 billion a year because the FCC finally did their job to verify people.
Seems the USG likes to operate on the "honor system" because with all those government workers they just can't be bothered to obtain and verify program eligibility.
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