Government Sends Obamacare Payments Without Verification

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Posted by Alexander Hendrie on Thursday, January 7th, 2016, 4:47 PM PERMALINK

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The Centers for Medicare and Medicaid Services (CMS) does not have adequate procedures in place to ensure tax credit payments were properly sent to enrollees as required by federal law, according to a new report by the Health and Human Services Office of Inspector General (HHS OIG).

The report marks the eighth time in less than a year that a government watchdog has raised concerns over the federal government’s ability to properly administer and monitor Obamacare.

As HHS OIG noted, CMS has “sole responsibility” for ensuring that tax credits were properly distributed to paying enrollees. Following this confirmation, the IRS is then responsible for reconciling tax credits with an enrollees' tax returns.

To meet this responsibility, CMS relied entirely on data from health insurers to verify whether enrollees had paid their premiums and were eligible. Unfortunately, this data was insufficient - insurers provided payment information on an aggregate rather than enrollee-by-enrollee basis, making verification all but impossible. 

Insufficient data and poor verification processes meant that CMS was not even able to determine whether improper payments had been returned:

"CMS had not yet established computer systems to enable marketplaces to share confirmed enrollment data; therefore, CMS did not verify that QHP issuers were returning APTC overpayments to Treasury."

This latest report raises just one of the many concerns that watchdog groups have flagged regarding the ability of the administration to properly implement and monitor Obamacare over the past year:

  • An October 23, 2015 report by the Government Accountability Office (GAO) found that Obamacare exchanges (both state and federal) were failing to verify key enrollment information of applicants including Social Security numbers, household income, and citizenship.


  • A September 1, 2015 report by the Treasury Inspector General for Tax Administration (TIGTA) found that Obamacare exchanges are failing to provide adequate enrollment information to the IRS for proper payment and verification of tax credits.


  • An August 2015 report by HHS OIG found that the federal exchange is failing to verify Social Security numbers, citizenship, and household income of Obamacare applicants. As a result, the exchange is unable to verify whether applicants are properly receiving tax credits.
  • A July 16, 2015 audit by GAO found that 11 of 12 fake 'test' applicants received coverage for the entire 2014 coverage period despite many using fraudulent documents, and others providing no documentation at all. From these 11 applicants alone, paid $30,000 in tax credits.


  • A June 16, 2015 report released by the HHS OIG found that $2.8 billion worth of Obamacare subsidies and payments had been made in 2014 without verification.


  • A June 10, 2015 TIGTA report found the IRS failed to properly administer nearly $11 billion in Obamacare tax credits.


  • A May 21, 2015 report by TIGTA found that the IRS failed to test Obamacare processing and verification IT until a week before the filing season began.



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