A House committee is accusing managers of the new public exchange program of encouraging enrollers to use biased information to hype the program.
Holes in enroller compensation rules “raise the risk of massive fraudulent spending on Medicaid and exchange subsidies for individuals who do not meet the eligibility requirements,” committee staffers say.
The staff of the House Oversight and Government Reform Committee make their case in a report on the risk of fraud at the public exchange outreach campaign.
Rep. Darrell Issa, R-chairman of the committee, had his staff look at U.S. Department of Health and Human Services (HHS) efforts to set up the Patient Protection and Affordable Care Act (PPACA) exchange navigator and “in-person assister” programs.
What Your Peers Are Reading
PPACA requires each state’s exchange to offer consumers “navigators,” or independent ombudsmen, to help the consumers understand how to use the exchanges. The Center for Consumer Information and Insurance Oversight (CCIIO), the arm of HHS running the exchange program, also has created a similar but separate “in-person assister” program.
House Oversight staffers say CCIIO set up the assister program to get around a PPACA provision that requires states to pay for their navigators with their own money. In the District of Columbia, for the example, the exchange expects to spend $100,000 in local money on navigators and $35 million in federal money on assisters.
The committee staffers say CCIIO is creating an opening for con artists to pretend to be exchange enrollers by failing to create an enroller database or giving the enrollers official badges.