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GAO: lets fake people re-enroll

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Investigators at the U.S. Government Accountability Office (GAO) have found that the U.S. Department of Health Human Services (HHS) still has little apparent ability to keep fake applicants from enrolling or re-enrolling in public exchange plans.

See also: GAO: HHS took too much security risk when it launched

Seto Bagdoyan, a director at the congressional watchdog agency, testified about the investigators’ findings today during a hearing on controls organized by the Senate Finance Committee.

He gave committee members an update on a project the GAO told the committee about a year ago.

See also: GAO: Federal PPACA exchanges are open to fake people 

A year ago, Bagdoyan gave senators a brief account of the GAO’s succcess at getting Patient Protection and Affordable Care Act (PPACA) exchange coverage for undercover investigators. This time around, Bagdoyan gave more details about exchange application processing, talked about how the fake enrollees dealt with identity-proofing checks, and shed some light on problems with in-person assisters.

The GAO investigators used public information to create documentation and life stories for 18 different fake Patient Protection and Affordable Care Act (PPACA) public exchange applicants. The investigators had six people apply for exchange coverage from the HHS exchange enrollment system, and six through a call center.

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The investigators also had six of the fake applicants try to apply for coverage through navigators and other in-person assisters, Bagdoyan testified, according to a written version of his testimony posted on the Finance Committee website.

Some of the fake applicants provided no Social Security number, or an invalid Social Security number. Many provided fake documentation of income or immigration status.

A call center rep bounced one of the fake applicants who refused to provide a Social Security number.

Exchange systems processed all of the other 11 and call center applications. The investigators got the applicants past identity-proofing problems by having them talk to call center reps and having the fake applicants fill in gaps with verbal attestations made under penalty of perjury, Bagdoyan said.

The GAO paid about $1,000 per month for the fake enrollees’ premiums and got them a total of about $2,500 in premium subsidies per month.

Three of the 11 fake exchange plan enrollees received inaccurate 1095-A forms from the exchange system.

The exchange eventually terminated the coverage of six of the 11 fake enrollees over allegations of documentation problems, but Bagdoyan said the GAO investigators won reinstatement of coverage, and increases in PPACA premium tax credit subsidies, for five of the six fake enrollees who lost their coverage.

Bagdoyan said the GAO cannot draw any conclusions about the performance of in-person assisters.

A fake GAO applicant was able to get help from one in-person assister. That assister, a navigator, correctly told the fake applicant that the fake applicant earned too much to qualify for a PPACA premium tax credit.

But “we were unable to obtain in-person assistance in five of six undercover attempts to test income-verification controls,” Bagdoyan said.

One in-person assister, at a health care facility, violated PPACA exchange assister program rules by stating that the assister’s organization could only help facility patients who owed the facility money.

Another assister said the assister’s organization was included in the exchange assister list by mistake.

Two in-person assisters had problems with keeping appointments.

A sixth assister violated assister program rules by encouraging the fake applicant to delete a fake application that was supposedly in progress before trying to qualify for the premium tax credit.

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