Obamacare marketplaces across the country approved fake applicants for health care insurance subsidies in an undercover federal investigation, according to a new Government Accountability Office (GAO) report.
California and the District of Columbia through their state-run marketplaces, and Florida and Virginia through the federal marketplace, approved nine of the 12 fictitious applicants GAO created for special enrollment and subsidies. That’s because there are no laws requiring marketplaces to verify whether someone is eligible for special enrollment outside the normal enrollment period for life events, like gaining a dependent through marriage or a making permanent move.
“While subsidies under the (Patient Protection and Affordable Care) Act are generally not paid directly to enrollees, participants nevertheless benefit financially through reduced monthly premiums or lower costs due at time of service, such as copayments,” the report said.
“Because subsidy costs are contingent on eligibility for coverage, enrollment controls that hep ensure only qualified applicants are approved for coverage with subsidies are a key factor in determining federal expenditures under the act,” the report added.
The approved nine fake applicants collected subsidies amounting to $18,960.
One of GAO’s fake applicants submitted a letter from a nonexistent doctor claiming the applicant couldn’t apply during open enrollment because of a medical condition. The marketplace approved the applicant’s case.
This isn’t the first time Obamacare marketplaces have failed GAO’s undercover investigations.
GAO in July, 2014, used 12 fictitious identities to apply for health care coverage under the federal marketplace, 11 of which were approved. GAO conducted a similar investigation in October, 2015, and was successful in 17 out of 18 attempts.