Although Paul Newman and Robert Redford probably wouldn't be impressed, the Government Accountability Office pulled a PPACA sting operation that revealed flaws in the application system.
The GAO's sting didn't catch any wrongdoers. It wasn't designed for that. But investigators in the federal watchdog office did set up 10 phony insurance coverage accounts with no pushback from those overseeing the applications.
The GAO, in testimony late last week before Congress, said it set up the sting to see if the U.S. Department of Health and Human Services had plugged up holes in the application system uncovered a year ago by a GAO study.
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Seto Bagdoyan of GAO's Forensic and Investigative Service, wrote that defrauding the application system was as easy as shooting fish in a barrel. The GAO used phony Social Security numbers and fictitious scenarios that should have been kicked out during application. Instead, all 10 of the instances were approved — and the GA even went so far as to purchase insurance coverage for the phony citizens.
GAO's takeaway: HHS needs to take its critiques seriously and tighten up the process. But HHS scoffed at the inquiry.
Few good Americans living life on the edge of poverty would go to the lengths that GAO did to try to get free or reduced premium coverage, a spokesperson said. Further, subsidies go to the insurance provider, not directly to the individual, so the motive for fraud is reduced by the system.
Worse, HHS spokesperson Meaghan Smith told NBC News, the GAO hasn't cooperated with HHS by fully sharing its findings.
"We have repeatedly requested and remain disappointed to still not receive from the GAO specific details and recommendations relating to their fraudulent applications to enable us to analyze and understand what occurred and whether we can make improvements to our processes or procedures," Smith said.
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
