Story first appeared: FoxNews.com
Undercover government investigators were able to obtain thousands of dollars in taxpayer subsidies under ObamaCare using fake identities, according to findings being presented to Congress on Wednesday.
The probe by the Government Accountability Office has raised fresh concerns about the ability of the sprawling health care program to prevent or intercept costly fraud schemes. In the case of the GAO investigation, 11 out of 12 applications submitted using "fictitious identities" were accepted, resulting in subsidized health coverage.
"For each of our 11 approved applications, we paid the required premiums to put policies into force, and are continuing to pay the premiums. For the 11 applications that were approved for coverage, we obtained the advance premium tax credit in all cases," the report said.
According to the GAO, the total amount for these credits was $2,500 monthly, adding up to $30,000 a year.
GAO officials were to testify about the findings before a House Ways and Means subcommittee Wednesday.
"We are seeing a trend with ObamaCare information systems: under every rock, there is incompetence, waste, and the potential for fraud," Rep. Dave Camp, R-Mich., chairman of the committee, said in a statement. "This law is already hitting Americans where it hurts the most - their pocketbooks. Now, this administration is forcing the American taxpayer to foot the bill for ObamaCare's waste and fraud."
Sen. Orrin Hatch, R-Utah, added: "Ironically, the GAO has found ObamaCare is working really well -- for those who don't exist."
The inquiries were carried out in several different states.
The administration pointed out that six of the GAO's fake online applications were blocked by eligibility checks built into computer systems at HealthCare.gov. Still, the GAO says its undercover agents found a way around that by phoning the call centers and were able to enroll anyway.
In six other applications, GAO investigators also tried to sign up fake applicants with in-person representatives. But in five of those cases, GAO was "unable to obtain in-person assistance" for various reasons, including one representative saying they could not help because HealthCare.gov was down.
"We are examining this report carefully and will work with GAO to identify additional strategies to strengthen our verification processes," administration spokesman Aaron Albright said. At least on paper, fraudsters risk prosecution and heavy fines.
The GAO said its investigators concocted fake identities using invalid Social Security numbers and falsely claiming citizenship or legal residence. In other cases, they made up income figures that would disqualify them from getting subsidies.
Among the findings:
--Contractors processing applications for the government told the GAO their role was not to ferret out potential fraud.
--Five of six bogus phone applications went through successfully. The one exception involved an applicant who refused to provide a Social Security number.
--Six online applications were snagged by an identity checking system. But investigators just dialed a call center and all six were approved. That seemed to be an open pathway to coverage.
Showing posts with label Health Insurance. Show all posts
Showing posts with label Health Insurance. Show all posts
Wednesday, July 23, 2014
Monday, October 25, 2010
Florida State Legislators approve Federal Guidelines for Health Insurance
Orlando Sentinel
Over the protests of the insurance industry, state insurance regulators meeting in Orlando today endorsed a proposed federal regulation that would guarantee a certain portion of your health-insurance premium is spent on medical care.
In a vote Thursday at the National Association of Insurance Commissioners' fall meeting, state regulators agreed to forward their proposal to the U.S. Department of Health and Human Services, which will either adopt or modify the recommendations.
The proposed regulations would require health-insurance companies to spend at least 80 percent of a customer's premium on providing health care and medicines. For customers covered by large-group plans, the insurance company must spend 85 percent of the premium on health-care.
These spending ratios, known as "medical loss ratios," have been the subject of contentious debates for months. Under the Patient Protection and Affordable Care Act passed by Congress in March, the insurance commissioners' association is responsible for recommending definitions and calculations of the ratios to federal officials.
For months, a committee of insurance commissioners held several conference calls with insurance industry officials and others while hammering out their recommendations for how the ratios should be calculated and implemented. The new rules will go into effect in January 2011.
"I commend the work of our regulators and staff as we considered a number of very challenging issues as it moved through the committee process," said Jane Cline, the West Virginia insurance commissioner and current president of the insurance commissioners' association.
HHS Secretary Kathleen Sebelius applauded the insurance commissioners' vote and pledged to work quickly to get a new MLR regulation into place.
"These recommendations are reasonable, achievable for insurers and will help to ensure insurance premiums are, for the most part, supporting health benefits for consumers," Sebelius said. "Not only do they ensure consumers receive better value for their health-care dollar, they recognize special circumstances in different markets to preserve market stability and employee coverage as we transition to the new marketplace in 2014."
Immediately after the vote, Karen Ignagni, president of the health-insurance lobbying group America's Health Insurance Plans, criticized the insurance commissioners' move.
"The current MLR proposal will reduce competition, disrupt coverage and threaten patients' access to health plans' quality-improvement services," Ignagni said.
Insurance industry experts and top attorneys have said insurers may not be able to operate at those levels — and have voiced concerns that some insurers may stop selling health-insurance policies in some areas.
But Timothy Jost, a health-law professor at Washington and Lee University in Virginia — and a consumer representative to the insurance commissioners' association — said some states, such as Washington state, already have these higher ratios.
"Washington's MLRs are in the 90s — and they still have health insurance companies operating in their state," he said. "And there are states that have regulated MLRs for years. They still have insurance industries."
He said the new rules would force insurers to spend less on marketing and administration — and to be efficient.
"There are insurers who are still processing with paper — and they're spending 35 percent of their premiums on administration," Jost said. "If we had an airline that was still printing tickets on paper, and charging higher prices, we wouldn't be using them."
In a vote Thursday at the National Association of Insurance Commissioners' fall meeting, state regulators agreed to forward their proposal to the U.S. Department of Health and Human Services, which will either adopt or modify the recommendations.
The proposed regulations would require health-insurance companies to spend at least 80 percent of a customer's premium on providing health care and medicines. For customers covered by large-group plans, the insurance company must spend 85 percent of the premium on health-care.
These spending ratios, known as "medical loss ratios," have been the subject of contentious debates for months. Under the Patient Protection and Affordable Care Act passed by Congress in March, the insurance commissioners' association is responsible for recommending definitions and calculations of the ratios to federal officials.
For months, a committee of insurance commissioners held several conference calls with insurance industry officials and others while hammering out their recommendations for how the ratios should be calculated and implemented. The new rules will go into effect in January 2011.
"I commend the work of our regulators and staff as we considered a number of very challenging issues as it moved through the committee process," said Jane Cline, the West Virginia insurance commissioner and current president of the insurance commissioners' association.
HHS Secretary Kathleen Sebelius applauded the insurance commissioners' vote and pledged to work quickly to get a new MLR regulation into place.
"These recommendations are reasonable, achievable for insurers and will help to ensure insurance premiums are, for the most part, supporting health benefits for consumers," Sebelius said. "Not only do they ensure consumers receive better value for their health-care dollar, they recognize special circumstances in different markets to preserve market stability and employee coverage as we transition to the new marketplace in 2014."
Immediately after the vote, Karen Ignagni, president of the health-insurance lobbying group America's Health Insurance Plans, criticized the insurance commissioners' move.
"The current MLR proposal will reduce competition, disrupt coverage and threaten patients' access to health plans' quality-improvement services," Ignagni said.
Insurance industry experts and top attorneys have said insurers may not be able to operate at those levels — and have voiced concerns that some insurers may stop selling health-insurance policies in some areas.
But Timothy Jost, a health-law professor at Washington and Lee University in Virginia — and a consumer representative to the insurance commissioners' association — said some states, such as Washington state, already have these higher ratios.
"Washington's MLRs are in the 90s — and they still have health insurance companies operating in their state," he said. "And there are states that have regulated MLRs for years. They still have insurance industries."
He said the new rules would force insurers to spend less on marketing and administration — and to be efficient.
"There are insurers who are still processing with paper — and they're spending 35 percent of their premiums on administration," Jost said. "If we had an airline that was still printing tickets on paper, and charging higher prices, we wouldn't be using them."
Subscribe to:
Posts (Atom)
