In a report, the Government Accountability Office said the Obama administration, specifically the Centers for Medicaid and Medicare Services, has taken a "passive" approach to identifying potential fraud involving the Affordable Care Act, according to Lowellsun.com.
Here are six insights:
1. The GAO found the Obama administration did not sufficiently resolve eligibility questions impacting the millions of initial applications and hundreds of thousands of consumers who were approved for benefits.
2. In response to GAO's report, the administration supports GAO's eight recommendations, but maintains the administration utilizes "best practices" to control fraud.
3. GAO Committee Chairman Rep. Fred Upton expressed great concern as the Department of Health & Human Services admits there are many vulnerabilities but "has no urgency or plan to fix these critical errors."
4. Some say healthcare fraud does not lie at the center of such errors, but attributes the errors to a convoluted documentation system that excludes hundreds of thousands of consumers who are legally entitled to benefits. HealthCare.gov excludes such consumers because their personal information may not match what is listed in government files.
5. HealthCare.gov has an electronic system called "data services hub" which verifies consumers' personal details when they apply for coverage. In its report, GAO claims the website fails to aggregate, track and analyze the results of data hub inquiries. The administration's lack of tracking "foregoes information that could suggest potential program issues or potential vulnerabilities to fraud," GAO said.
6. The agency concluded the administration's process for amending documentation issues is not highly reliable, as 31,000 applications from 2014 still had unresolved paperwork issues in April of 2015.
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