The Obama administration has been making billions of dollars in payments to insurance companies under the health law without being able to confirm just how much it owes each insurer, according to an inspector general’s report to be released Tuesday.
The federal government has paid subsidies for many enrollees’ premiums and deductibles directly to insurers since January 2014, when key health-law changes kicked in and millions of lower-income Americans started gaining coverage from plans they picked through HealthCare.gov or state equivalents.
But the back-end system for the Centers for Medicare and Medicaid Services to determine the exact amounts the government owes for each enrollee still hasn’t been completed.
While it is being built, insurers have been submitting estimated claims to the federal government, which has been paying the claims without knowing for sure whether they are accurate—or if enrollees are even current on their share of the premiums.
In all, the Obama administration didn’t have a firm grip on the almost $2.8 billion paid to insurers from January through April 2014, the inspector general for the Department of Health and Human Services concluded after studying a sample of the payments during that period.
The HHS Office of Inspector General said it couldn’t determine whether payments were correct, and therefore it considered the situation to be risky.
“Because CMS has not developed the systems to obtain enrollment and payment information on an enrollee-by-enrollee basis, CMS cannot verify the accuracy of the nearly $2.8 billion it authorized for financial assistance payments during our audit period,” the report concluded.Read the rest of the story HERE.
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