Instead, CMS relied on payers to verify enrollees had paid their monthly premiums and to provide accurate tax-credit payment information, according to the OIG. While the report did not identify CMS made any overpayments to payers, it identified a potential loophole in the process where overpayments could have occurred.
CMS said it plans to automate the payment process and the majority of payers offering plans on the federal marketplace will be able to start using the automated process early this year.
This report follows an August report from the OIG that found not all of the internal controls in the marketplace effectively determined applicants’ eligibility, including validating Social Security numbers, citizenship, household income and family size.
In July, the U.S. Government Accountability Office found fictitious applicants on HealthCare.gov were able to re-enroll in 2015 and receive subsides.
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