Dive Brief:
- A new report from the Government Accountability Office (GAO) says those in charge of the public health insurance exchange system data services hub have been lax in analyzing how well it's working.
- The hub helps HealthCare.gov and state-based ACA exchange programs decide who is eligible for exchange plan subsidies by comparing application information with that from the IRS and other services.
- The data hub does not store individual information that can be later analyzed and the CMS told the GAO the agency did not want to store the sensitive personal data "for policy reasons."
Dive Insight:
The GAO report showed CMS left inconsistencies for 431,000 applications submitted in 2014 unresolved. Those applicants received close to $1.7 billion in exchange plan subsidies. It also revealed thousands of applications with Social Security problems, which could thwart IRS efforts in determining if taxpayers reported exchange plan subsidies properly on their tax returns. However, CMS determined the Social Security number conflicts were best left to immigration or citizen authorities to resolve.
In a summary of the report, the GAO wrote, "CMS hasn't performed a comprehensive fraud risk assessment - a recommended best practice - of the PPACA enrollment and eligibility process. Until such an assessment is done, CMS is unlikely to know whether existing control activities are suitably designed and implemented to reduce inherent fraud risk to an acceptable level."