HHS works to correct 2 million data discrepancies in marketplace applications

McClatchy Washington BureauJune 4, 2014 

— The Obama administration is contacting millions of Americans who signed up for marketplace health insurance about apparent discrepancies in the personal information they provided in their coverage applications.

As the inconsistencies involving some two million marketplace plan members are verified and resolved, some could end up losing their coverage or having to repay government subsidies that were overly generous if outright falsehoods are uncovered.

"Two million consumers are not at risk of losing coverage --they simply need to work with us in good faith to provide additional information that supports their application for coverage and we are working through these cases expeditiously," said a statement from Julie Bataille, communications director at the Centers for Medicare and Medicaid Services. "We are working with consumers every day to make sure individuals and families get the tax credits and coverage they deserve and that no one receives a benefit they shouldn't."

Bataille said about 1.2 million pieces of questionable information deal with applicants’ personal income, about 505,000 pieces relate to immigration status and 461,000 others deal with applicants' citizenship status.

The health law provides a 90-day window to resolve the discrepancies and about 59 percent of marketplace enrollees are still within that window, Bataille added.

Congressional Republicans pounced on the latest development as another example of the Obama administration's flawed rollout of the health care law.

“Administration officials allowed applications to be processed before the information provided was fully vetted and verified. What’s worse is the system to process these discrepancies is still incomplete, leaving an antiquated mail and phone system to address the millions of questions in applications,” said a statement by House Energy and Commerce Committee Chairman Fred Upton, (R-MI). “More than eight months after the start of open enrollment, the exchanges are still not built and accurate information remains hard to come by.”

On Wednesday, Upton's committee released an HHS slide presentation that outlined the problem applications and the efforts of a government contractor, Serco, Inc. to resolve the problems.

A blog Bataille posted on HHS.gov on Wednesday said most consumer data was immediately verified by the marketplace. But "sometimes a name or data point didn't match up right away with existing records."

The blog cited as an example, an applicant who recently changed jobs, but their change in income wasn't reflected in current government tax records. "In such cases the law requires us to double and triple check this data in another way," Bataille wrote.

Those with information discrepancies are being asked via e-mail, phone calls and standard mail, to submit additional information. Eligibility support workers are trying to confirm the information, but the verification process will likely take several months.

The effort to resolve the problem applications comes as Senate is expected to vote Thursday on Sylvia Mathews Burwell's bid to replace Kathleen Sebelius as the new Health and Human Services Secretary.

The insurance application problems stem in part from an Obama administration policy that allowed consumers to self-report personal information about their incomes, citizenship, household size, all of which help determine their eligibility for tax credits to help pay for coverage.

The self-reporting system was adopted because the federal marketplace technology to verify all applicant information wasn't fully functional.

In the first year of operation, the federal exchange used a scientific sampling process to weed out applications that understated household income. Income declarations were also checked against credit reporting bureau data and IRS records.

The House Ways and Means Committee has scheduled a hearing on June 10 to address concerns about data verification of health insurance information.

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