Category: Investigations

“Woefully sloppy and willfully ignorant” is how Chairman Tim Murphy (R-PA) described the oversight of the state-run health insurance exchanges at an Energy & Commerce oversight hearing Tuesday.

Andy Slavitt, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), testified before the subcommittee on the use of federal funds provided to establish state-based marketplaces under the Affordable Care Act.

CMS doled out more than $5.5 billion in grant money to construct exchanges in 17 states, but lawmakers now question whether this money has been used properly. Chairman Murphy noted that every single state exchange faces significant budget shortfalls. For example, $733 million was given to establish state exchanges in Hawaii, Nevada, New Mexico, and Oregon. All four exchanges failed to become self-sustaining and were forced to transition consumers to the federal marketplace. It is increasingly unclear whether or not the money will be recouped.

Congresswoman Marsha Blackburn (R-TN) questioned Slavitt about a recent report from the Government Accountability Office which revealed that some state exchanges’ information technology systems were still functioning improperly. The report found that CMS “did not always clearly document, define, or communicate its oversight roles and responsibilities to states as called for by best practices for project management.” State administrators say communication with CMS has been poor, which “adversely affected states’ deadlines, increased uncertainty, and required additional work.”

CMS is charged with reviewing states’ funding requests and conducting audits to ensure all money is being spent legally. After January 1, 2015, states were not allowed to spend grant money on operation expenses such as rent, utilities, telecommunications, or software maintenance. Chairman Murphy cited a report from the Office of Inspector General revealing that Washington state may have used its grant money for operational costs, contrary to law.

Slavitt contended all current state marketplaces are sustainable despite these compelling challenges. When asked by Congressman David McKinley (R-WV) whether anyone has lost their job for giving erroneous advice to the state exchanges, Slavitt was unable to provide a single name.

Tuesday’s hearing was the second Energy & Commerce oversight hearing to address the tumultuous problems within the state marketplaces in an effort to ensure that taxpayer dollars are being spent wisely and in accordance with the law.

Cassandra Gekas, operations director for Vermont Health Connect, said staff members are working on a problem in which hundreds of people who paid their monthly premiums on time were canceled for nonpayment. Apparently, the cancellations were related to a five- to seven-day period it takes for the system to process end of the month payments. Vermont Health Connect was plagued with technical glitches and security problems after its launch Oct. 1, 2013.

When Oregon Attorney General Ellen Rosenblum filed suit against Oracle last year, she claimed the contractor “repeatedly lied and defrauded the state” during the course of its work on the failed Cover Oregon health exchange. The defunct health exchange website cost $300 million in federal grants, which could mean that even if Oregon prevails in court and wins a judgment for the billions it is seeking, the state might not be able to keep any of it.

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.