U.S. Payments to Health Insurers Still Lack Verification – your tax dollars at work😉

imageOf course this tale of incompetence is not unique to the Obama administration, rather it is typical of massive government bureaucracy. What’s amazing is that most people accept this state of affairs as normal and indeed many Americans see more of the same federal involvement as the solution to just about every problem, especially “inequality.”  Just take more in taxes and throw the money into this morass.

From the HHS report:


We determined that CMS’s internal controls (i.e., processes put in place to prevent or detect any possible substantial errors) for calculating and authorizing financial assistance payments were not effective. Specifically, we found that CMS:

 relied on issuer attestations that did not ensure that advance CSR payment rates identified as outliers were appropriate,

 did not have systems in place to ensure that financial assistance payments were made on behalf of confirmed enrollees and in the correct amounts,

 did not have systems in place for State marketplaces to submit enrollee eligibility data for financial assistance payments, and

 did not always follow its guidance for calculating advance CSR payments and does not plan to perform a timely reconciliation of these payments.


WASHINGTON—The Obama administration has been making billions of dollars in payments to insurance companies under the health law without being able to confirm just how much it owes each insurer, according to an inspector general’s report to be released Tuesday.

The federal government has paid subsidies for many enrollees’ premiums and deductibles directly to insurers since January 2014, when key health-law changes kicked in and millions of lower-income Americans started gaining coverage from plans they picked through HealthCare.gov or state equivalents.

But the back-end system for the Centers for Medicare and Medicaid Services to determine the exact amounts the government owes for each enrollee still hasn’t been completed.

While it is being built, insurers have been submitting estimated claims to the federal government, which has been paying the claims without knowing for sure whether they are accurate—or if enrollees are even current on their share of the premiums.

In all, the Obama administration didn’t have a firm grip on the almost $2.8 billion paid to insurers from January through April 2014, the inspector general for the Department of Health and Human Services concluded after studying a sample of the payments during that period.

The HHS Office of Inspector General said it couldn’t determine whether payments were correct, and therefore it considered the situation to be risky.

“Because CMS has not developed the systems to obtain enrollment and payment information on an enrollee-by-enrollee basis, CMS cannot verify the accuracy of the nearly $2.8 billion it authorized for financial assistance payments during our audit period,” the report concluded.

via U.S. Payments to Health Insurers Still Lack Verification – WSJ.

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