GOP Touts GAO Report Finding ACA Marketplace Vulnerable to Fraud

The Affordable Care Act marketplace sign-up verification process is still vulnerable to fraud, a Government Accountability Office undercover investigation found.

GOP lawmakers are touting the report from the nonpartisan watchdog agency as part of the law’s weakness. Rep. Fred Upton (R-Mich.), the chairman of the Energy and Commerce Committee, said the Obama administration must take action to cut down on fraud within the system.

“When a fire is raging, the first thing you do is grab a hose — but there is no urgency by the administration,” Upton said in a statement. “It’s déjà vu all over again as it seems the situation only continues to get worse, and we all are paying the price.”

The agency submitted 15 fictitious applications to the marketplace, and many were approved for coverage and financial assistance by the Obama administration. Previous GAO investigations had found similar results.

“As previously reported for the 2014 and 2015 coverage years, GAO’s undercover testing for the 2016 coverage year found that the health-care marketplaces’ eligibility determination and enrollment processes remain vulnerable to fraud,” the report says.

Of the 15 applications submitted, the initial payments for three applications were not successfully processed. Otherwise, the agency used four identities from 2014 that had been approved for subsidized coverage, and all were approved for 2016 subsidies despite not having filed 2014 tax returns. The agency used another eight newly-created identifies.

Of those 12, five applications were approved and the applicants were able to retain coverage, three were able to retain coverage with partial documentation and for another three the GAO did not provide the requested documentation. Two of those applications maintained coverage, while coverage was terminated for one applicant.

The Centers for Medicare and Medicaid Services told the GAO that “some of GAO’s application outcomes could be explained by decisions to extend document filing deadlines,” according to the report.

“Continuing to leave taxpayers vulnerable, years after the system was implemented, is a disgraceful way for the administration to leave our healthcare system,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said in a statement. “That the administration has been aware of this since 2014, and has failed to employ proper safeguards, is just the latest incompetence in the health law’s implementation.”

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