The Centers for Medicare and Medicaid Services (CMS) cannot ensure that $2.8 billion in subsidies for Obamacare customers was accurately paid to insurance companies in 2014, the Department of Heath and Human Services Office of Inspector General found in a new report.
"CMS's internal controls for calculating and authorizing financial assistance payments were not effective ... CMS did not have systems in place to ensure that financial assistance payments were made on behalf of confirmed enrollees and in the correct amounts ... The internal control deficiencies that we identified limited CMS's ability to make accurate payments to qualified health plan issuers," the report said.
The investigation found that CMS could not ensure the correct financial assistance payments were made during the period January through April 2014.
"Without effective internal controls for ensuring that financial assistance payments are calculated and applied correctly, a significant amount of Federal funds are at risk," the report said.
The OIG suggested that "CMS correct these internal control deficiencies by requiring its Office of the Actuary to review and validate QHP issuers' actuarial support for index rates that CMS identifies as outliers, implementing computerized systems to maintain confirmed enrollee and payment information so that CMS does not have to rely on QHP issuers' attestations in calculating payments, implementing a computerized system so State marketplaces can submit enrollee eligibility data, following its guidance for calculating estimated advance CSR payments, and developing interim reconciliation procedures to address potentially inappropriate CSR payments."
Last week, the Treasury's inspector general said the IRS is unable to verify whether Obamacare subsidy recipients are actually eligible for the government assistance they receive, The Washington Times reported.
Yesterday, Rep. John Boehner, R-Ohio, said Obamacare is "fundamentally broken" and that Republicans plan to move "forward on legislation to bring reform and innovation to our health care system," according to Newsmax. "Americans can't afford it, and so the House is going to take action this week on solutions that will lower costs and expand access to quality health care."
Meanwhile, all eyes are on the Supreme Court, which is expected this month to make a critical decision on Obamacare subsidies that could lead to the loss of health insurance for millions of Americans. If subsidies are ruled illegal by the court, the Obama administration has said it would ask Congress to preserve the federal assistance with a one-page bill clarifying that aid is available in all states, The Los Angeles Times reported. However, congressional Republicans have indicated they won't support such a bill unless major changes are made to the health law.
