A House committee is accusing public exchange managers of encouraging enrollers to use biased information.
Holes in enroller compensation rules "raise the risk of massive fraudulent spending on Medicaid and exchange subsidies for individuals who do not meet the eligibility requirements," committee staffers say.
Rep. Darrell Issa, R-chairman of the committee, had his staff look at U.S. Department of Health and Human Services efforts to set up the Patient Protection and Affordable Care Act navigator and assister programs.
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PPACA requires each state's exchange to offer consumers navigators, or independent ombudsmen, to help them understand how to use the exchanges. The Center for Consumer Information and Insurance Oversight, the arm of HHS running the exchange program, also has created a similar but separate assister program.
House Oversight staffers say the assister program is meant to circumvent a PPACA provision that requires states to pay for navigators with their own money. In the District of Columbia, for the example, the exchange expects to spend $100,000 in local money on navigators and $35 million in federal money on assisters.
The committee staffers say CCIIO is creating an opening for con artists to pretend to be exchange enrollers by failing to create an enroller database or giving the enrollers official badges.
Even the official enrollers may go to work with less than 20 hours of training, and no independent entity maintains oversight over the content of the training or the information the enrollers distribute, staffers say.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
