Obamacare Payments to Health Insurers Wildly Inaccurate

debtThe Office of the Inspector General of the U.S. Department of Health & Human Services has concluded that the administration has no clue if the billions of dollars it is paying to health insurers as Obamacare tax credits and cost-sharing subsidies are accurate:

We determined that CMS’s internal controls (i.e., processes put in place to prevent or detect any possible substantial errors) for calculating and authorizing financial assistance payments were not effective. Specifically, we found that CMS:

  • relied on issuer attestations that did not ensure that advance CSR payment rates identified as outliers were appropriate,
  • did not have systems in place to ensure that financial assistance payments were made on behalf of confirmed enrollees and in the correct amounts,
  • did not have systems in place for State marketplaces to submit enrollee eligibility data for financial assistance payments, and
  • did not always follow its guidance for calculating advance CSR payments and does not plan to perform a timely reconciliation of these payments.

The internal control deficiencies that we identified limited CMS’s ability to make accurate payments to QHP issuers. On the basis of our sample results, we concluded that CMS’s system of internal controls could not ensure that CMS made correct financial assistance payments during the period January through April 2014.

Just another day of Obamacare news.

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