Report: vulnerable to fraudNews added by Benefits Pro on February 25, 2016

Benefits Pro

Joined: September 07, 2011

My Company

By Jack Craver

The Centers for Medicaid and Medicare Services aren’t doing enough to prevent customers from cheating Obamacare, states a new report from the Government Accountability Office.

Of 12 GAO agents posing as fictional applicants for insurance, 11 were able to acquire subsidized health plans through in 2014.

Worse, all of those who obtained insurance were able to keep their insurance throughout the entire year by sending in fraudulent documentation or no documentation at all.

“CMS has not performed a comprehensive fraud risk assessment — a recommended best practice — of the PPACA enrollment and eligibility process,” said the report. “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.”

The red flag from the GAO will no doubt draw renewed criticisms of PPACA from Republicans, as well as from insurers that have complained that the system is vulnerable to exploitation from those who seek to buy insurance only when they need medical treatment.

Insurers have said that the administration has been allowing far too many to enroll using “special enrollment periods.” Those who sign up for insurance during such periods tend to be more expensive, insurers have claimed.

In addition to requesting more vigilance from the Obama administration, a number of insurers have said they will not pay brokers’ commissions for such customers directed to their plans.

In trying to reduce fraud, CMS faces the risk of cracking down so hard that many deserving applicants will be denied care. Last year, for instance, some alleged that many eligible customers were rejected because they could not prove their citizenship status.

Nevertheless, CMS announced last month a series of restrictions on special enrollment periods.

Originally posted on
The views expressed here are those of the author and not necessarily those of ProducersWEB.
Reprinting or reposting this article without prior consent of is strictly prohibited.
If you have questions, please visit our terms and conditions
Post Press Release