GAO Slams Further Obamacare Verification Lapses
by Scott Hamilton, Tax-News.com, Washington
13 September 2016
Undercover testing by the US Government Accountability Office (GAO) has found that the health insurance marketplaces set up under the Affordable Care Act (ACA) remain "vulnerable to fraud."
It said they may still grant access to individuals who are ineligible to enroll in qualified health plans and receive the premium tax credit (PTC).
The ACA's refundable PTC assists eligible taxpayers with paying their health insurance premiums. Individuals may elect to receive the tax credit as a lump sum credit on their annual federal income tax return, or to have the credit paid directly to their health insurance provider during a year as partial payment for their monthly premiums.
GAO noted that the ACA requires health-insurance marketplaces to verify application information to determine eligibility for enrollment and, if applicable, determine eligibility for the income-based PTC. Verification steps include validating the applicant's Social Security number, if one is provided; citizenship or immigration status; and household income.
It added that the 2016 coverage year, which ran from November 1, 2015, to January 31, 2016, "was the first year in which a key eligibility requirement – verification of whether applicants who previously received [the PTC] filed federal tax returns, as a requirement to retain that benefit – went into effect."
GAO was asked to review this year's marketplace enrollment and verification controls. Its review related, in particular, to perceived failings in marketplace controls over whether health insurance applicants had made the required income-tax filings, and on applicants' identity or citizenship/immigration status. It made 15 fictitious applications in Virginia, West Virginia, and California, and the marketplaces initially approved health coverage and PTCs (where applicable) for all of them.
Reacting to GAO's report, House of Representatives Ways and Means Committee Chairman Kevin Brady (R – Texas) said that "the fact that the exchanges are so susceptible to fraud is just further proof that the President's health care law is not working as promised – and wasting billions of taxpayer dollars in the process."
Senate Finance Committee Chairman Orrin Hatch (R – Utah) added that "the Obama Administration continues to fail the test when it comes to enrollment verification. … That the Administration has been aware of this since 2014, and has failed to employ proper safeguards, is just the latest incompetence in the health law's implementation."
To see today's news, click here.
Tax-News Reviews

A review and forecast of Cyprus's international business, legal and investment climate.

A review and forecast of Malta's international business, legal and investment climate.

A review and forecast of Jersey's international business, legal and investment climate.

A review of the latest budget news and government financial statements from around the world.
Stay Updated
Please enter your email address to join the Tax-News.com mailing list. View previous newsletters.
By subscribing to our newsletter service, you agree to our Terms and Conditions and Privacy Policy.
To manage your mailing list preferences, please click here »
Network Blogs and Features
- Multilateral Moves Ongoing »
- EU Advances On Trade And Tax »
- Budgets Are Go... »
- How a virtual office can help your Hong Kong small business? »
- COVID Campaigns Continue »
- US Occupies Center Stage »
- Big changes Afoot... »
- I.T. is IT! »
- What Is a Registered Agent, and Why You Need a Registered Agent for Your Business? »
- Spring Cleaning? »