The Government Accountability Office (GAO) warned Friday that gaps in ObamaCare are clearing the way for redundant payments and fraud.
The federal watchdog found that some people have duplicate coverage, meaning that they are enrolled both in Medicaid and in private coverage through the law’s marketplaces. The report said that means that the government could be incorrectly paying twice for someone’s coverage through both programs.
The report said the Centers for Medicare and Medicaid Services (CMS) has some checks in place but that they could be improved. The GAO recommends that the administration establish a schedule for regular checks for duplicate coverage and develop a plan to monitor the effectiveness of those checks. As of July, the CMS did not have regular checks for duplicate coverage but planned to begin them and concurred with the recommendations, the GAO said.
There is no estimate in the report of how many people have duplicate coverage; the GAO says the number is “limited” because a relatively small proportion of people transitioned between Medicaid and exchange coverage but that the number could grow.
The GAO also found that the federal government could be paying the wrong share of a Medicaid enrollee’s costs. The federal government pays 100 percent of the cost under ObamaCare’s Medicaid expansion but a smaller share under the traditional core of the program. The GAO found that there could be mixups between the two categories leading to the wrong share of federal payments.
Separately, the GAO also followed up on an earlier investigation where it created fictitious identities and applied for ObamaCare coverage. The GAO found that while eight of the 10 were initially rejected, all 10 were eventually able to enroll. Four used Social Security numbers that have never been issued, such as numbers beginning “000.”
The Obama administration says it has checks in place to prevent fraud and that the GAO’s scenarios of repeated efforts to get around those barriers are unrealistic. It says that people have nothing to gain financially by fraudulently signing up for health insurance and having to pay new premiums and deductibles.
“It’s important to consider whether it’s likely that uninsured Americans would replicate the next actions the GAO took, namely knowingly and willfully providing false information in violation of federal law, which could subject the individual to up to a $250,000 fine,” said Department of Health and Human Services spokeswoman Meaghan Smith.
At a hearing on the reports on Friday, Rep. Frank Pallone Jr. (N.J.), the top Democrat on the Energy and Commerce committee, took the GAO to task for its focus on creating fictitious identities.
“For you to spend your time and your effort, taxpayer money, in trying to make it more difficult or trying to highlight the difficulties, I just don’t understand,” he said. “It’s inconceivable to me that some of the most vulnerable individuals in this country would have the desire, time, money and expertise to try over and over again to fraudulently gain coverage.”
He said the other reports, on duplicate Medicaid and exchange coverage, raised more important issues but that the CMS is already implementing the GAO recommendations and said that Republicans are using the issue for political gain.
“If it were not for Republicans continual mission to undermine the ACA, these reports could have provided a good policy discussion,” he said.
Rep. Marsha Blackburn (R-Tenn.) argued that the administration is being careless on fraud issues because they are so eager to sign people up.
“It was really get the numbers up, so they’ve really thrown the door open for fraud,” she said.