Lewis & Ellis Inc.

Researchers signed fake people up for health insurance exchanges

Health Care and Health Insurance
by Tom Handley
U.S. health spending vs. outcomes: What's the issue?
U.S. health spending vs. outcomes: What's the issue?

There were a number of rather notable developments and controversies surrounding the implementation of the health insurance exchanges mandated by the Patient Protection and Affordable Care Act over the last year-plus. Now, new evidence suggests that it was also relatively easy for people to sign up and qualify for coverage when providing falsified or inaccurate information.

As part of a test to see just how easy it was to be approved for coverage through phone calls and the Healthcare.gov website, experts at the nonpartisan Government Accountability Office tried to obtain subsidized insurance through the site using 18 fake names, and recently told Congress that 11 of those attempts - more than 60 percent - were successful, according to a report from the Associated Press. In fact, these bogus accounts weren't even shut down after the Obama administration tried to do more to root out inaccurate data submitted by applicants. One round of this process actually led to the fake information being verified by the federal government. Interestingly, of the six attempts to sign up a fake person via a phone call, five were successful, with the only failure coming because the "applicant" did not provide a Social Security number.

Moreover, it's important to note that those more recent verification efforts successfully turned up hundreds of thousands of cases of improperly submitted or inaccurate data, the report said. In all, there are still some 600,000 such cases that have to be dealt with by the Obama administration, though obviously only a fraction of that percentage will likely end up constituting outright fraud.

On the other hand
However, it's also important to note that the GAO believes there's little actual benefit for Americans who are hoping to defraud the system if they can breach the government's verification processes, the report said. This is because the subsidies from the federal government are actually paid to insurance companies, and not to individuals - meaning that these people will still be obtaining and paying for relatively low-cost health insurance. For its part, the Obama administration says it will carefully examine the GAO's data and use that information to reconfigure its verification processes further.

Health insurance providers might want to think about the ways in which they can help consumers who remain unsure of the value of participating in the health insurance exchanges find the coverage they need to remain compliant with federal law.



Consultants to Contact