CMS failing to verify income, citizenship for Healthcare.gov credits, OIG report says

Deficiencies included improper verification of Social Security numbers, citizenship, annual household income and family size.

Internal controls are lacking when it come to setting an individual's eligibility for tax credits and cost sharing reductions for health plans bought through Healthcare.gov, according to a new report by the Office of the Inspector General.

The Affordable Care Act provides for two types of insurance affordability programs: the premium tax credit; and cost-sharing reductions that help with out-of-pocket expenses such as deductibles, coinsurance, and copayments.

Health plan shoppers may be eligible for both.

Once an application is filed, it goes through a Data Hub, which verifies the information through the Department of Health and Human Services, the Social Security Administration, the U.S. Department of Homeland Security, and the IRS, among others.

[Also: HHS: Tax incentive hits $268 per month for Healthcare.gov enrollees]

However, the Office of the Inspector General found that of 45 samples audited, 20 had inconsistencies in eligibility data.

Certain controls were effective, such as verifying whether an applicant served a prison sentence, according to the OIG.

Deficiencies included improper verification of Social Security numbers, citizenship, annual household income and family size. Inconsistencies related to annual household income were often resolved using an applicant's response to income discrepancy questions, the OIG found.

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Inspector General Daniel Levinson recommends the Centers for Medicare and Medicaid Services improve the internal controls to avoid these issues.

The OIG reviewed controls that were in place during the last three months of the open enrollment period January through March 2014 plus the special enrollment periods of April 1 through April 15, 2014, and April 16 through April 19, 2014. OIG conducted interviews with marketplace management, staff, and contractors; observed staff performing tasks related to eligibility determinations; and reviewed supporting documentation and enrollment records.

Twitter: @SusanMorseHFN