“GAO was asked to examine enrollment into the FFM for PY 2015, the most current data available at the time of GAO’s review. This report examines the extent to which indications of potentially improper or fraudulent enrollments existed in the FFM’s application, enrollment, and eligibility-verification process for the 2015 enrollment period.”
“A small percentage—about 1 percent—of plan year (PY) 2015 enrollments were potentially improper or fraudulent. These applicants had unresolved inconsistencies related to citizenship, status as a national, lawful presence, or Social Security number (SSN), or received coverage while reportedly deceased, according to GAO’s analysis of federally facilitated marketplace (FFM) eligibility and enrollment data.”
“GAO recommends that CMS assess and document the feasibility of approaches to identify the deaths of individuals prior to automatic reenrollment…”
Source: Analysis of Plan Year 2015 Application, Enrollment, and Eligibility-Verification Process – January 23, 2018. GAO. Read the full report here.
