Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.
When consumer advocates tried to call the obstetrician-gynecologists in the online directory of insurers’ in-network providers on the Maryland state exchange, they found that only about 22% of the 1,493 practitioners were accepting new patients, performed well-patient visits and had appointments available within four weeks. More than a third weren’t available at all because they had left the networks, retired or were dead.
The Government Accountability Office (GAO) found that the ObamaCare health insurance exchanges are still easily tricked by fake Social Security numbers and immigration details, even more than one year after the weakness was first pointed out. The GAO also found that many have been double-covered by private insurance and Medicaid after enrolling in an exchange plan. “Our undercover testing for the 2015 coverage year found that the health care marketplace eligibility determination and enrollment process remains vulnerable to fraud,” said Seto Bagdoyan of GAO’s Forensic and Investigative Service wrote a testimony before the House Energy and Commerce Committee’s health subcommittee.
One of the 12 failed co-ops created under Obamacare is now under investigation by regulators after the co-op was found to have downplayed its poor financial condition in official filings, the Daily Caller reported. The New York State Department of Financial Services (NYDFS) found that the Health Republic of New York co-op’s “financial condition is substantially worse than the company previously reported in its filings.”
Federal investigators from the Government Accountability Office said on Thursday that they had discovered many errors in eligibility decisions under the Affordable Care Act that had led the government to pay for duplicate coverage for some people and an excessive share of costs for others.
The investigators said some people were getting subsidies for private insurance at the same time they were enrolled in Medicaid.
Federal officials have a secret list of 11 Obamacare health insurance co-ops they fear are on the verge of failure, but they refuse to disclose them to the public or to Congress, a Daily Caller News Foundation investigation has learned.
Just in the last three weeks, five of the original 24 Obamacare co-ops announced plans to close, bringing the total of failures to nine barely two years after their launch with $2 billion in start-up capital from the taxpayers under the Affordable Care Act.
Kentucky sometimes failed to ensure that all consumers who signed up for insurance on the state’s health exchange were eligible for coverage, the latest federal audit found.
The audit, released Thursday by the inspector general for the Department of Health and Human Services, found that some of the Kentucky exchange’s controls for confirming consumers’ eligibility weren’t effective. Earlier audits also identified deficiencies in the federal exchange, Healthcare.gov, as well as state-run exchanges in California, Connecticut and New York.
The operators of Maryland’s health insurance Web site improperly stored Social Security numbers and other customer information while awarding millions of dollars in contracts without ensuring the money would be spent properly, according to a state audit released Friday.
The audit is the latest in a string of reports uncovering loose spending and rushed decision-making involving the once-troubled Maryland Health Benefit Exchange, which the state hurried to create to help enact President Obama’s ambitious federal health-care overhaul.
Representatives from the 18 nonfederal initiatives GAO reviewed described a variety of efforts they are undertaking to achieve or facilitate electronic health record (EHR) interoperability, but most of these initiatives remain works in progress. EHR interoperability is the ability of systems to exchange electronic health information with other systems and process the information without special effort by the user, such as a health care provider. These initiatives’ efforts include creating guidance related to health data standards, encouraging the adoption of certain health data standards or policies that facilitate interoperability, and operating networks that connect EHR systems to enable interoperability.
Lackluster enrollment numbers, technology issues, and high maintenance costs are among the challenges plaguing ObamaCare state exchanges that were reviewed by the House Energy and Commerce Oversight Subcommittee at a hearing Tuesday.
“CMS has seemed more focused on doling out taxpayer dollars rather than overseeing how those dollars are spent,” Chairman Tim Murphy (R-PA) said of the lack of oversight.
Executives from six state exchanges—Oregon, Massachusetts, Hawaii, California, Minnesota, and Connecticut—provided testimony. So far, Oregon and Hawaii’s exchanges have both proven to be unsustainable, closing down and migrating consumers to HealthCare.gov’s federal marketplace with others likely to follow.
Chairman Murphy emphasized in his opening statement the sufficient amount of taxpayer money that was poured into creating these now-failing exchanges: “The Centers for Medicaid and Medicare Services has awarded $5.51 billion dollars to the States to help them establish their exchanges. Let me repeat that. The States received $5.51 billion in federal taxpayer dollars to set up their own exchanges. Yet, the ACA had no specific definition of what a state exchange was supposed to do, or more importantly, what it was not supposed to do.”
Grant money used to fund the exchanges was cut off in 2015 when states were expected to start bringing in enough money to continue operation on their own. Of the 17 states that chose to establish their own exchanges, nearly half face financial difficulties.
The committee hopes to find out why exchanges have struggled to become self-sustaining and whether or not any grant money will be recouped from states where exchanges have been shut down. For instance, Oregon spent $305 million of taxpayer dollars to establish its failed exchange, while Hawaii spent $205 million.
As Americans for Tax Reform points out, Tuesday’s hearing is a vital first step to addressing the urgent problems within the state exchanges—before they spread to all 17.
This audit was initiated as part of our continued coverage of the IRS’s implementation of key Affordable Care Act tax provisions. The overall objective of this review was to determine whether the IRS has developed processes to identify providers required to file premium reports, assess penalties on those that did not, and accurately determine health insurance providers’ market shares and applicable annual fees.