(/sites/default/files/uploads/2013/09/fraud-scam.jpg)A congressional report, issued by Republicans on the House Oversight and Government Reform Committee on September 18, 2013, is warning that a key portion of the Patient Protection and Affordable Care Act (Obamacare) program is being mismanaged and is under threat for abuse and fraud. This report follows another report on the same Obamacare program which also warned the program was susceptible to fraud.
Exchanges were set up in Obamacare to provide a marketplace for individuals not covered by their employer’s health insurance or by Medicare/Medicaid. These exchanges were supposed to be set up by each individual state, but about half refused and forced the federal government to set up exchanges in those states.
“Navigators” were written into the law to be individuals who would help consumers navigate the exchanges and help consumers understand their option to choose the best insurance plan. Because half the states didn’t set up exchanges, “navigators” weren’t set up either. As a result, the Obama administration has set up the federal program of “assisters” a group of federally funded individuals who will help consumers navigate exchanges to find the best deal.
According to the House Oversight and Government Reform Committee, there is clear language in Obamacare which specifies that only state, not federal funds, be used to fund the “navigator” program, making this new program an end run around the clear language of the statute, according to the report.
In a press release, the Committee identified five specific areas of concern for fraud in the “navigator” program: 1) The Administration created the Assisters program without congressional approval, 2) top HHS officials have admitted that the enrollment outreach programs are prime targets for fraud, 3) consumers have no way to verify that someone taking their application or encouraging enrollment is actually a Navigator or Assister, 4) HHS officials were concerned about security risks, but did not look into whether or not they could require background checks, 5) HHS has criticized direct phone calls, door-to-door solicitation, but has not banned them, and in some states, Navigators and Assisters are paid based on the number of persons they enroll, creating a conflict of interest.
The report also pointed out that navigators won’t go through a background check, be required to only have twenty hours of training, and have access to all sorts of personal information which they’ll be authorized to enter into a central database. The congressional report said:
Individual Navigators and Assisters will have access to many applicants’ personally identifiable information (PII), including Social Security numbers, dates of birth, home addresses, email addresses, and in many cases the PII for other members of the applicant’s household. Such information may also be stored on computers and scanners owned by Navigator and Assister organizations. Furthermore, unlike agents and brokers, Navigators and Assisters bear no personal liability if they give taxpayers misinformation that damages their financial interests.
An email to the HHS media relations department for comment on this story was left unreturned.
The House Oversight and Government Reform Committee wasn’t the only committee expressing concern about the navigator program. Members of the House Energy and Commerce Committee also fired off a letter last week to Gary Cohen, the Deputy Administrator and Director of the Center for Medicare and Medicaid, expressing their concerns that the navigator grant program was also ripe for fraud.
This is not the first time that fraud has become an issue in the health care exchanges. In August an HHS Office of Inspector General report warned that security in the information technology system that would put all health care plans in each exchange on-line was so far behind schedule in its implementation that the final test would only happen on September 30, the day before the exchanges were due to be fully operational.
Separately, the $2 billion loan program to augment Health Care Co-ops is now the subject of four separate investigations with allegations of fraud being so systemic the program has been shut down entirely while the investigations go on. Health care Co-ops are non-profits, which would offer health insurance in certain state exchanges to compete with for profit health insurance providers.
With less than a week before Obamacare is to be fully implemented, most news stories are concerned with the economic effects of the law. Fraud, identity theft, and other crimes should be of concern as well since this complicated program is being put together on the fly, with all sorts of individuals being hired to help implement, whether they are qualified to do so or not.
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