HHS: Most HealthCare.gov Application Discrepancies Unresolved

By Christine Kern, contributing writer

The most common inconsistencies involved citizenship and income.

A full 90 percent of the 2.9 million inconsistencies discovered on insurance applications submitted through the federal exchange remain unresolved by the federal government, according to a report issued Tuesday by HHS' Office of the Inspector General. Roughly three-quarters of those inconsistencies dealt with either income or immigration status.

Specifically, the Federal marketplace was unable to resolve 2.6 million of 2.9 million inconsistencies because the CMS eligibility system was not fully operational, the report reveals. State marketplaces had varying levels of ability to resolve inconsistencies, with four State marketplaces reporting that they were unable to resolve inconsistencies, seven reporting that they resolved inconsistencies without delay, one reporting that it resolved only some inconsistencies, and three reporting that their State Medicaid offices resolved inconsistencies.

The study also found that data on inconsistencies are limited. For example, the Federal marketplace could not determine the number of applicants who had at least one inconsistency. Finally, marketplaces faced challenges resolving inconsistencies despite having policies and procedures in place.

In contrast, the 14 state-run exchanges and the District of Columbia's exchange appear to have had slightly more success in resolving inconsistencies found on insurance applications. Seven exchanges reported no problems in resolving data discrepancies, while three others indicated that any inconsistencies were dealt with by their state Medicaid office. However, four states reported that they were unable to rectify discrepancies on exchange applications. And only 11 of the 15 state-run exchanges provided actual data detailing inconsistencies to the OIG investigator.

The OIG report stressed, however, that each applicant can have multiple inconsistencies. Inconsistencies do not necessarily indicate that an applicant provided inaccurate information or is enrolled in a qualified health plan or is receiving financial assistance through insurance affordability programs inappropriately.

Republicans were quick to use the report as further evidence of the failure of the ACA to meet expectations. Rep. Fred Upton (R-MI), chair of the House Energy and Commerce Committee claimed in a statement, "Vital portions of the exchanges still sit incomplete, generating serious questions about the system's ability to process inconsistencies or handle next year's open enrollment period. The reports underscore the perils of the administration's incompetence, the reckless rollout and the systemic disregard for taxpayer dollars."

Flagging of an application normally occurs when there are discrepancies between information provided by an applicant and that found in the federal data hub, including records from the Internal Revenue Service, the Social Security Administration and the Department of Homeland Security, among other agencies.

In a statement responding to the report, HHS stressed that vast progress has been made in resolving those issues and that individuals with imperfect applications have been contacted multiple times to resolve the issues.

"CMS is working expeditiously to resolve inconsistencies to make sure individuals and families get the tax credits and coverage they deserve and that no one receives a benefit they shouldn't," the statement said. "We are actively reaching out to consumers to provide additional information that supports their application for coverage and verifying their information every day."

"To date there has been no evidence of an applicant defrauding the (federal marketplace) or a state-based marketplace in order to unlawfully enroll in a (health plan) through the marketplace or take advantage of an insurance affordability program for which the applicant is not eligible," the report noted.

The OIG report recommended that HHS come up with a detailed plan for reconciling discrepancies found in applications submitted through the federal exchange and a means for tracking its progress. In addition, it recommended that the federal agency heighten its scrutiny of state-run exchanges to make sure they are dealing with problematic applications in a timely manner. HHS indicated in its response to the report that it would follow through on both recommendations.