Healthcare.gov’s internal controls did not effectively determine eligibility for coverage because Social Security numbers and citizenship status were not always verified properly, according to a Department of Health and Human Services (HHS) audit.
The Inspector General (IG) investigated HHS to determine whether the Federal marketplace’s internal controls determined correctly whether individuals were eligible for qualified health plans.
The IG found that the internal controls did not always correctly verify Social Security numbers, citizenship status, annual household income, and family size information to determine eligibility.
One applicant understated her income by $7,000. According to the IG, the marketplace should have compared this income data to available electronic data sources and realized that the applicant’s income was more than 10 percent below the income listed on these data sources. Then, the marketplace should have asked the applicant for additional evidence of income.
Instead, this applicant was not only verified, but was approved to receive the advance premium tax credit.
Another example of weak internal controls was found in efforts to verify citizenship status. The marketplace did not always verify this information through the Social Security Administration and the Department of Homeland Security, as was required.
The IG found that not only were there problems with internal controls, but once discrepancies were found, they were not handled properly.
In one case, an applicant who had a discrepancy related to his citizenship status was approved after the marketplace accepted the applicant’s birth certificate without obtaining a second document.
According to the Centers for Medicare and Medicaid Services’ guidance for acceptable documentation of citizenship, when an applicant submits a birth certificate, they must also submit either a driver’s license or a school identification card.
This report comes on the heels of a Government Accountability Office (GAO) report that found Healthcare.gov approved coverage for fake accounts. GAO performed undercover tests and fabricated personal data of fake applicants for coverage under Obamacare. In 11 of 12 of these fake applications, the online marketplace approved coverage and granted each account $30,000 in premium tax credits.
"Obamacare is not working," said Nathan Nascimento, senior policy adviser at Freedom Partners, in a statement. "After millions of tax dollars have been wasted, Americans are left with higher costs, fewer options, and an incompetent Washington bureaucracy to oversee the chaos."