The results of an undercover investigation conducted by the Government Accountability Office were presented Thursday at Senate hearing, the GAO report showed that federal auditors 11 out of 12 times were able to gain subsidized coverage with fictitious applications, three of the successful applications never provided citizenship or immigration documentation.
The investigators in each case were able to obtain $2,500 or around $30,000 annually in advance premium tax credits. The GAO also purposely had seven of the 11 applicants not submit all required verification to the federal Health Insurance Marketplace, “but the Marketplace did not cancel subsidized coverage for these applicants.”
It is important to note that these fictitious applications were successful primarily over the phone, Bloomberg reports. They couldn’t be completed online, as the website wouldn’t verify their identities, and when done in person only one out of six phony applicants were successful.
The GAO report states that, “The APTC and CSR subsidies are not paid directly to enrolled consumers; instead, the federal government pays them to issuers of health-care policies on consumers’ behalf. However, they represent a benefit to consumers—and a cost to the government—by reducing out-of-pocket costs for medical coverage.”
The applicants also, “submitted none, or only some, of the documentation we were directed to send, we retained our coverage for all 11 applicants through the end of the 2014 coverage year.”
The Marketplace terminated subsidized coverage for six of the 11 applicants in early 2015, though they restored coverage for five of these applicants, even giving them larger subsidies. They got these larger subsidies without even asking for them.
When going through a “Navigator,” a third-party option, one applicant was asked whether he wished to volunteer for a labor union organization. The Center for Medicare and Medicaid Services said that there is no formal policy or specific guidance for that situation, though that navigators are discouraged from asking applicants such questions.
Meaghan Smith, a spokeswoman for the Department of Health and Human Services, was proud of the website’s success in deterring false applications and wrote in a e-mail that the agency has improved, “our processes and communications for those with a data matching issue as we work to bolster the integrity of the process.”
