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Two fake GAO applicants got duplicate exchange plan coverage

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Both the public health insurance exchanges that use the HealthCare.gov enrollment system and the surviving state-based, state-run exchanges continue to have a hard time applying applicant screening rules.

The applicant screening system is so weak that two fake consumers who applied to re-enroll for health coverage through a state-based exchange, and for new coverage through state-based exchange programs, each received 2015 health coverage, both through the HealthCare.gov exchange system and through a state-based exchange.

Seto Bagdoyan, a director at the U.S. Government Accountability Office (GAO), presented those findings in a summary of the work of undercover GAO investigators. Bagdoyan testified about the investigation Thursday at a hearing organized by the House Energy & Commerce health subcommittee.

The investigators were following up on undercover exchange screening investigations they began during the open enrollment period for 2014 health coverage.

See also: GAO: HealthCare.gov lets fake people re-enroll

The investigators filed 10 applications for private qualified health plan (QHP) coverage for 2015 through the Patient Protection and Affordable Care Act (PPACA) exchange system, and eight applications for Medicaid coverage through the exchange system. In each case, the investigators created an applicant who should have had obvious problems with getting covered.

When the investigators created the QHP applicant scenarios, for example, they gave four of the applicants “impossible Social Security numbers,” such as numbers beginning with 000 or 666, or numbers ending with 0000.

Four other fake applicants pretended not to have access to affordable employer-sponsored coverage. One tried to apply for coverage both through HealthCare.gov and Covered California, and a second tried to apply through HealthCare.gov and Kentucky’s Kynect exchange.

For the eight fake Medicaid applicants, the GAO created scenarios involving missing or invalid Social Security numbers.

See also: Democrats: PPACA exchanges are working

A California call center rep refused to provide Medicaid coverage over the phone for a fake applicant who refused to provide any Social Security number.

A Kentucky call center rep noted that a fake QHP applicant had provided an invalid Social Security number, but the rep ignored a manual verification requirement and let the fake applicant have QHP coverage anyway.

Some of the other applicants had to submit fake documents, but they did get the coverage they sought.

Exchange managers told GAO investigators they only inspect supporting documentation if the documentation has obviously been altered.