Auditors uncover possible Obamacare fraud; NCPA fellow responds
Recent auditor findings, which point to possible massive fraud, have caused another setback for the ACA.
“I believe there are three distinct reasons for fraud in the ACA,” Devon Herrick, health economist and senior fellow at the National Center for Policy Analysis (NCPA), recently told Patient Daily. “First, CMS is a big bureaucracy, and the ACA expanded that bureaucracy. Second, the systems that needed to be linked to verify eligibility are also bureaucracies -- linking them together is very complex. And third, the Obama administration so wanted the ACA to succeed that fraud checks might create barriers to enrollment that could reduce enrollment.”
Herrick continued by explaining how these new findings of fraud do not fare well for ACA.
“The problems have had a negative effect on the success of the program,” he said. “Many people are getting subsidies they should not receive.”
It goes beyond simple fraudulent claims, Herrick argues. How people are using the system as a whole is not supposed to be allowed.
“People are enrolling and disembroiling when they are not technically allowed to,” he said. “Some of the state exchanges have done a better job policing enrollment and have not experienced as much fraud.”
Despite its problems -- even with the recent findings -- the ACA is trying to remedy the situation by means of tighter monitoring.
“HealthCare.gov has finally had to implement some changes where people trying to enroll through a special enrollment period now have to prove they are eligible,” Herrick said. “With better policing of enrollment, the risk pools will be healthier, premiums will be lower and insurers more stable.”
Herrick’s suggestions to remedy the situation require a straightforward response.
“The best strategies are to scrutinize applications to verify eligibility for subsidies and eligibility for special enrollment periods,” he said.