CMS unable to verify $2.8B in payments to insurers

CMS put $2.8 billion at risk between January and April 2014 by not effectively tracking subsidies paid to insurers under the Patient Protection and Affordable Care Act, according to a report issued Tuesday from the HHS Office of Inspector General.

The OIG report revealed CMS used an interim process during the first four months of the PPACA that relied on payers to attest that deductible subsidies were accurate, did not ensure confirmed enrollees received payments for the correct amounts and left state-based marketplaces with no way to submit enrollee eligibility data.

CMS also "does not plan to perform a timely reconciliation of these payments," according to the report. CMS issued a statement in February that it will delay the reconciliation of deductible subsidy payments until 2016.

CMS officials said a permanent process to track and verify PPACA subsidies is still not in place, however it expects to implement an authorization process on an enrollee-by-enrollee basis later this year, according to the report.


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