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July 26, 2014 01:00 AM

Fictitious applicants easily get ACA subsidies: GAO

Paul Demko
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    While federal courts last week ruled on the legality of insurance subsidies issued from federally run exchanges, Congress was hearing about another, much more dollars-and-cents subsidy issue, namely how easy it apparently is for consumers to lie to obtain subsidies.

    A Government Accountability Office report detailed how investigators were able to fraudulently obtain subsidized insurance coverage for fictitious applicants through the federal exchange in 11 of 12 instances when applying online or over the phone. The report touched off the expected political charges and countercharges that have characterized the life of the Patient Protection and Affordable Care Act.

    “This is not simply a question of whether one likes the president's healthcare law or the way his administration has gone about implementing it,” said Rep. Charles Boustany (R-La.), chairman of the House Ways and Means Committee's Oversight Subcommittee. “The question is whether the administration is being a good steward of taxpayer dollars and is putting in place adequate controls to protect those dollars from fraud, waste and abuse.”

    Democrats countered that even if individuals are submitting incorrect information they won't be benefiting financially. Federal subsidies are sent directly to insurers providing coverage, they argued, ignoring perhaps that consumers who may have lied about their income to obtain them would be paying lower premiums and thus saving money that way. They also pointed out that individuals submitting false information could face significant civil penalties, and even criminal prosecution, if they are caught.

    “It's just another attempt, I think, to try and smear the Affordable Care Act,” said Rep. Joseph Crowley (D-N.Y.). “All the doomsday predictions haven't come true.”

    The volley and countervolley came July 23 at an Oversight Subcommittee hearing. Seto Bagdoyan, acting director of the GAO's forensic audits and investigative service, cautioned at the hearing that the GAO's investigation is not complete and that the preliminary results shouldn't be used to draw conclusions about the 8 million applications filed through the state and federal exchanges.

    Roughly 85% of individuals who enrolled in coverage through HealthCare.gov were eligible for subsidies. The 11 fictitious individuals who investigators were able to obtain coverage for with erroneous information or fraudulent documents qualified for about $30,000 in subsidies annually.

    Follow Paul Demko on Twitter: @MHPDemko

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