Auditor: CMS Was ‘Passive’ in Preventing Fraud in Administering Obamacare

Report finds 34% of applications had inconsistencies, involving $1.7 billion in subsidies

The Centers for Medicare and Medicaid Services was “passive” in its approach to identifying and preventing fraud in administering Obamacare, according to testimony from the Government Accountability Office.

According to the report, the agency must verify an individual’s application information to determine he or she is eligible for health care coverage. The individual must be lawfully present in the United States and may not be incarcerated unless they are awaiting a disposition of charges.

The agency detects application “inconsistencies” when an individual’s personal information is not correctly matched against the data from other federal agencies such as the IRS, the Social Security Administration, and the Department of Homeland Security.

“[The Centers for Medicare and Medicaid] did not terminate or adjust subsidies for any applications with incarceration or Social Security number inconsistencies,” the audit states. “[Agency] officials told us that they currently do not plan to take any actions on individuals with unresolved Social Security number or incarceration inconsistencies.”

The investigators found that for coverage year 2014 the agency did not resolve about one-third of applications with inconsistencies, which involved $1.7 billion in associated subsidies.

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