Dive Brief:
- Investigators performing an undercover study for the Government Accountability Office have succeeded, for the second time, in obtaining subsidized health plans through HealthCare.gov by using fake identities and documentation.
- The results continue upon the first investigation in July 2014, during which the investigators succeeded in 11 of 12 attempts to use fake documents to get plans and subsidies.
- The second time, the group reports, HealthCare.gov automatically renewed all 11 of the fake applicants for 2015 coverage. Although six of those were later flagged for termination, the GAO investigators were able to get five reinstated using fake documents—and were awarded even higher subsidies than in 2014.
Dive Insight:
The CMS has reportedly dumped hundreds of thousands of illegal immigrants from the exchange for their inability to verify legal status, but the GAO's investigation indicates that verification is still lacking a year after their initial report.
"Overall, the Marketplace did not terminate any coverage for several types of inconsistencies, including Social Security data or incarceration status," the report found. It also noted that HealthCare.gov provided incorect information to its fake applicants in three cases.
HealthCare.gov is not set up to detect fraud, says GAO audits and investigations chief Seto Bagdoyan, and the contractor that processes documents for the website is not required to perform antifraud duties.