The Department of Health and Human Services (HHS) is on track to open the health insurance exchange on Oct. 1 despite “mischaracterization” and “confusion,” according to the main administrator of the exchanges.
Marilyn Tavenner, administrator of the HHS’ Centers for Medicare & Medicaid Services (CMS), wrote a July 9 blog post to clear up myths that she said were generated in the wake of the employer mandate postponement and coverage about final regulations it released Friday on eligibility for the exchanges.
No matter which type of exchange is operating in a state, be it federally-facilitated or state-based, the marketplace mechanism will always check the income information submitted by individuals against electronic income data sources such as tax filings, Social Security data and current wage information, Tavenner wrote.
Tavenner was seeking to dispel what CMS called a myth—namely, that income information submitted by individuals on the exchange won’t be checked and that the exchanges would encourage fraud.
“In most circumstances, we will request additional documentation from all affected individuals, such as when an individual does not have a tax return on file and attests to an income significantly below current wage data,” Tavenner wrote.
In addition, CMS will ask for more documentation from a random sampling of individuals in certain instances, such as when there appears to be a significant discrepancy between the income reported on an available tax return and the income provided by the individual and there is no acceptable explanation for the discrepancy. Or, simply, when there is no current income information available.
As for fraud, there are safeguards to ensure that individuals do not fraudulently access premium tax credits, Tavenner said. The IRS is on the job and will be reconciling advance payments of the premium tax credit when consumers file their annual tax returns at the end of the year. The IRS will recoup overpayments and provide refunds when they occur.
Also, those seeking to purchase insurance in the Marketplace must attest, under penalty of perjury, that they are not filing false information. In addition to that, PPACA applies penalties when an individual provides false or fraudulent information.