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.
More articles on finance:
10 thoughts on improving hospital collections
High deductible and low deductible enrollees have difficulty meeting care costs
Study finds ACA does not promote part-time employment: 6 key findings
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
