Nonpartisan Watchdog Finds Gross Negligence at CMS and Lax Oversight of Obamacare’s Eligibility Controls

With Billions of Dollars at Stake, Enrollment Rife with Inconsistencies – Poor Oversight Opened the Door for Fraudsters, Prisoners, and Illegal Immigrants to Enroll

WASHINGTON, DC – Senate Finance Committee Chairman Orrin Hatch (R-UT), House Energy and Commerce Committee Chairman Fred Upton (R-MI), House Ways and Means Committee Chairman Kevin Brady (R-TX) and Senator Rob Portman (R-OH) today released the results of a new report from the nonpartisan Government Accountability Office (GAO) expressing concerns with lax oversight and weak eligibility controls of Obamacare’s data hub and federal exchange.

GAO cites several concerning findings about the Centers for Medicare and Medicaid Services (CMS) oversight and mismanagement of Obamacare, including:

Ignored opportunities for reducing fraud in Obamacare
By failing to perform even basic analysis, GAO reports, “CMS foregoes information that could suggest potential program issues or potential vulnerabilities to fraud, as well as information that might be useful for enhancing program management.”

Failure to resolve one-third of 2014 applicant inconsistencies, which lingered into 2015
According to GAO analysis of CMS data, there were approximately 431,000 applications from the 2014 enrollment period, or one-third of all applications, that had inconsistencies identified during that period. These applications were connected to $1.7 billion in associated subsidies for 2014. GAO found that these inconsistencies had yet to be resolved as of April 2015 – several months after close of that coverage year, and well into the second calendar year of coverage.

Approved subsidized coverage without Social Security numbers, allowing access to illegal immigrants or fraudsters
GAO found that CMS did not resolve Social Security number inconsistencies for approximately 35,000 applications – amounting to $154 million in associated subsidies.

Wrongly granting health coverage to prisoners
GAO found that CMS did not resolve incarceration inconsistencies for approximately 22,000 applications – amounting to $68 million in associated subsidies. Additionally, CMS told GAO “the agency elected to rely on applicant attestations on incarceration status” and, in its comments on a draft of the report noted that it “no longer requires application filers to submit documentation regarding incarceration status.”

“As the health law nears its sixth year on the books, the administration continues to put enrollment numbers ahead of protecting taxpayers. This was predicted,” said Hatch. “When Democrats were forcing the law through Congress, Republicans repeatedly warned the law’s tax credits would be susceptible to waste, fraud and abuse. Now, as the Congress’s nonpartisan watchdog confirms, billions of taxpayer dollars continue to be at risk due to the administration’s gross inability to implement a working verification system on the federal exchange. The administration owes it to taxpayers to follow GAO’s recommendations and come clean on this egregious waste of taxpayer dollars.”

“One thing is clear – CMS has been asleep at the wheel with billions of taxpayer dollars at risk,” said Upton. “This laundry list of concerns showcases systemic problems throughout Obamacare, and broad mismanagement at CMS. These complex, massive problems represent what we’ve known all along – Obamacare is full of broken promises.”

“The president’s healthcare law has been riddled with problems since day one, and millions of Texans have suffered the consequences,” said Brady. “The systemic failures highlighted in GAO’s new report are further proof Obamacare is not working and must be repealed and replaced. We cannot afford to waste another taxpayer dollar on this broken healthcare system.”

“The GAO’s important work highlights HHS’ continuing problems in verifying subsidy eligibility and underscores the need for serious, responsible oversight of HHS’ efforts,” said Portman.

Click here to read the report online.

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