The inspector general for the Department of Health and Human Services released a report highlighting problems verifying eligibility for federal health insurance subsidies under the Affordable Care Act.
Here are five issues the IG found in place as of Feb. 23:
1. Fraud could be significant. The audit found the federal government has been unable to resolve 2.6 million out of 2.9 million “inconsistencies” in the information provided by people who applied for health care subsidies. In other words, it could not verify the data provided by people seeking subsidies.
2. Most inconsistencies were about citizenship and income. The vast majority of the questionable data provided by those receiving health care subsidies relate to citizenship and income level. The audit found that 44 percent of inconsistent information concerned verifying citizenship or lawful presence. Income information made up 33 percent of the potentially faulty data, and in 11 percent of cases, the government couldn’t verify whether a person was truly ineligible for employer-sponsored insurance.
3. The healthcare.gov site is still not working perfectly. According to the audit, one health care marketplace was unable to verify the information on 15,000 applications because of outages on the federal website for verifying data. The federal data hubs also contained old and inaccurate information. In some cases, for example, infants were identified as “incarcerated.”
4. The healthcare.gov site is still incomplete. According to the audit, the federal government was unable to resolve inconsistent data from subsidy applicants because the system “was not fully operational.” In fact, the government was not able to determine how many applicants with whom the government had at least one problem verifying the information they provided.
5. Some state-run marketplaces have problems, too. Four states do not have the capacity to determine how many applicants for health care subsidies have provided potentially faulty information. Nevada and Oregon reported their systems “were not built with the capacity to provide that data.” In Colorado and Minnesota, health care marketplace officials relied on state Medicaid offices to do the verifying and said they had no access to the information.