OIG lays out plans for mon­i­tor­ing in­sur­ance ex­changes

Modern Healthcare - - NEWS - By Dar­ius Tahir

HHS’ watch­dog agency will be scru­ti­niz­ing the Oba­macare in­sur­ance ex­changes over the ac­cu­racy of pay­ments to in­sur­ers and providers, con­sumer el­i­gi­bil­ity for pre­mium sub­si­dies, in­for­ma­tion tech­nol­ogy con­tract­ing, and the se­cu­rity and pri­vacy of in­for­ma­tion.

Kay Daly, the as­sis­tant in­spec­tor gen­eral for the Of­fice of Au­dit Ser- vices within HHS’ Of­fice of In­spec­tor Gen­eral, out­lined her of­fice’s over­sight strat­egy dur­ing a testy hear­ing last week be­fore the House En­ergy and Com­merce Com­mit­tee. The hear­ing fo­cused on in­ad­e­qua­cies of the sys­tems used for check­ing ap­pli­cant in­con­sis­ten­cies, which were brought to light in an OIG re­port re­leased ear­lier this month.

The hear­ing was con­vened be­cause of that re­port, which un­cov­ered 2.9 mil­lion in­con­sis­ten­cies be­tween con­sumers’ in­sur­ance ap­pli­ca­tions and their in­for­ma­tion in federal data­bases.

For 90% of those in­con­sis­ten­cies, HHS had to re­sort to a man­ual res­o­lu­tion sys­tem, as op­posed to the au­to­matic, IT-en­abled sys­tem en­vi­sioned when the ex­changes first started.

Go­ing for­ward, the OIG will an­a­lyze the el­i­gi­bil­ity func­tions of the state-based ex­changes.

It also is “look­ing at sev­eral as­pects of the con­tract­ing in­volved in the de­vel­op­ment of Health­Care.gov,” Daly said. The OIG should be pre­pared to re­port on its find­ings by year-end or the be­gin­ning of 2015, she said.

Repub­li­cans at the hear­ing fo­cused on the po­ten­tial for the in­con­sis­ten­cies to lead to fi­nan­cial pain for con­sumers. They asked whether the in­con­sis­ten­cies meant that many ap­pli­cants had mis­stated their in­come and re­ceived im­proper sub­si­dies, and ques­tioned how those sub­si­dies would be re­cov­ered.

OIG wit­nesses replied that in­come mis­state­ments and im­proper sub­si­dies were pos­si­ble, and those sub­si­dies would be re­cov­ered through the In­ter­nal Rev­enue Ser­vice.

That re­ply prompted a wor­ried re­sponse from com­mit­tee mem­bers. Rep. Leonard Lance (R-N.J.), said that IRS re­view of in­cor­rect sub­sidy lev­els might re­sult in “many un­happy sur­prises in spring 2015” if con­sumers found out they owed much more federal tax than ex­pected be­cause of the IRS’ need to re­cover in­cor­rectly ap­plied sub­si­dies.

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