Inspector General Finds CMS Payments to Insurers Often Inaccurate

Because the back-end of HealthCare.gov is still unable to accurately calculate subsidies owed to Obamacare sign-ups, the Centers for Medicare and Medicaid Services (CMS) has been relying on estimates provided by insurers of what is owed them, according to an audit by the Office of the Inspector General (OIG). According to the audit, "On the basis of our sample results, we concluded that CMS's system of internal controls could not ensure that CMS correctly made financial assistance payments...." Under the Affordable Care Act (ACA), qualifying health insurance applicants can receive federal assistance to offset the cost of their monthly premiums, but the back-end system for determining the amounts owed is still unfinished, according to a report about the audit in today's Wall Street Journal. According to the OIG report:

Under CMS’s interim process for approving financial assistance payments in effect during our audit period, issuers submitted to CMS a monthly 'Enrollment and Payment Data Template' covering enrollees in all of the issuers’ plans. Each template contained the aggregate financial assistance amounts that the issuer submitted for reimbursement on the basis of its confirmed enrollment totals. Confirmed enrollees were defined as those who had paid their first month’s premium to the QHP [Qualified Health Plan] issuer and had their enrollment information approved by the issuer.

Though the audit covered just the first enrollment period under the ACA in 2013-2014, the problem persists, according to the Wall Street Journal.

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