The Department of Health & Human Services’ Office of the Inspector General found that the Centers for Medicare & Medicaid Services (CMS):
• Did not have an effective process in place to ensure that advance premium tax credit (APTC) payments were made only for enrollees who had paid their monthly premiums; instead, CMS relied on each qualified health plan (QHP) issuer to verify that enrollees paid their monthly premiums and to attest that APTC payment information that the issuer reported on its template was accurate; and
• Had sole responsibility for ensuring that APTC payments were made only for confirmed enrollees and did not share these data for enrollees with the IRS when making payments.
The OIG determined that CMS’s processes limited its ability to ensure that APTC payments made to QHP issuers were only for enrollees who had made their premium payments.
