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Affordable Care Act Exchanges Fail To Detect Counterfeit Documentation (atr.org)
Tulsa_Time writes with this excerpt of an account from the (unapologetically partisan) Americans for Tax Reform about a report released by the Government Accountability Office in which "application and enrollment controls on the federal exchange and two state exchanges (California and Kentucky)" were investigated by supplying false information; in each case, the investigators were able to obtain and activate health insurance through the exchanges. A slice:
Ten fictitious applicants were created to test whether verification steps including validating an applicant's Social Security number, verifying citizenship, and verifying household income were completed properly. In order to test these controls, GAO's test applications provided fraudulent documentation: "For each of the 10 undercover applications where we obtained qualified health-plan coverage, the respective marketplace directed that our applicants submit supplementary documentation we provided counterfeit follow-up documentation, such as fictitious Social Security cards with impossible Social Security numbers, for all 10 undercover applications."
I'm sure submitting false information on those forms is illegal. So, make sure all the people responsible go to jail.
This is the typical charge for obtaining gov't assistance under many different false pretenses, but typically under-reporting income.
I, for one, would prefer to keep the trust but verify nature of the programs... the aim is not to catch fraudsters straight away, but to help folks when they need it. Sure, some will game the system, but likely not for an extended period before getting caught with the hand in the cookie jar.
Happiness in intelligent people is the rarest thing I know.
Ernest Hemingway
You want to arrest the GAO for fraud, for doing their actual job?
That's who wrote the report. Americans for Tax Reform just reported on it.
If they are running the checks it means they are using them as a "manual override" against their internal data(which may be flawed). These checks exist to redistribute wealth via price discrimination according to a "means" test. If a person can claim to make less money than they actually do: the idea of selling a commodity below market price falls apart and attempts at rationing quickly become unsuccessful.
If the auditors scammed them successfully, that is "smoke" to the fire of a process breakdown. Gasp! It isn't 100% effective. It's true.
While true, you ignore the fact that they started skyrocketing long before Obamacare was passed.
OTOH, if you mean that the insurance companies should be cut out of the healthcare system, I agree completely. I'm in favor of free coverage for everyone without all the god-damn middlemen that have tripled the price. (And I mean that as in "God damned the sheep and they died.". Those insurance parasites should just drop dead...or at least be rapidly put on unemployment.)
I think we've pushed this "anyone can grow up to be president" thing too far.
I, for one, would prefer to keep the trust but verify nature of the programs
I would if there was any "verify". There was not.
People claim the U.S. should emulate Europe, but it seems they go mysteriously silent when it comes to emulating the controls that Europe has to make healthier care voting work to prevent fraud. If a system has endemic fraud it will eventually fail.
"There is more worth loving than we have strength to love." - Brian Jay Stanley
This class warfare thing is hilarious. The "elite" aren't suffering from this system designed to encourage fraud. I'm sure folks that are making a million dollars a year could care less about what amounts to a rounding error when it comes to the cost of their insurance. It's the MIDDLE class that's getting soaked here. The rich don't care.
Single payer. Book it done.
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The pro-ACA people don't care about screening out fake applicants. They think any person getting another government handout is a good thing, regardless of circumstance.
It's interesting that you describe health care as a "handout", and bolster the metaphor with "regardless of circumstances".
There are perhaps three dozen examples of government-funded health care in the world that we can look to as examples. The US health care ranks worse than all of the top 10 countries.
Framing it as "it's a government handout" implies the subtext "(that you do not deserve)", and is a bit of a misnomer. Our system is horribly broken, we pay 6x as much as other countries and for that price get substandard care.
In short, many *many* people suffer needlessly because our health care system isn't a government handout.
So... I don't see a problem here. We do in fact deserve better health care. We're the US, we *were* the best.
Would you care to explain why a government handout is bad, in this specific instance?
(And before someone asks "well, how do you propose we fix it?", let me just say that we could find a system we like and copy it wholesale. For example, the Canadian system is better than the US system overall, and we could simply copy their procedures and implement them. If we did that, 80% of the money we now spend on health care would be available to stimulate the economy.)
Quality/accuracy auditing takes money. There's usually a brake-even point where the savings from catching problems is less than the cost of auditing as more auditors are added. We'd need more info to know where the break-even point is.
I suspect it may not be a real problem as long as they check credentials when an expensive procedure or treatment is done, such as surgery or an expensive medication.
Before such, as long as the "fakes" pay their insurance fees, they are not a (significant) cost drain to the system.
In short, fraud happening on the enrollment end may not be a practical problem.
Table-ized A.I.
How about if in the course of applying, the fake person also describes a lifestyle that qualifies them for completely subsidized care that other people get to go to work every day to buy for them? This is no different than any other of benefit fraud
Well, it is different, an insurance is just paper (contract), when you obtain the contract to benefit a person that doesn't exist, you've acted in bad faith and obtained a contract that is invalid by nature.
:)
So your chances of successfully upholding the contract is slim. That said, yesm the fake people could probably get some care, before the private insurance company starts looking at the details... This is another problem with private insurance, if there is a problem with contract the insurance company will declare it invalid (but they won't do so before you file a claim, ie. only when do it when you the insurance).
But yes, this is great
Note. insurance contracts in the US are in my experience, super sketchy have through my employer and had to fight very hard to get any kind of actual paper... and I'm still not satisfied that I have sufficiently strong contract to sue my insurance provider should it come to that, and certainly not if my employer decided not to look out for my interest (which I don't have contract saying they will). So legally speaking I'm is a poor standing (despite working for tech company, and having an good PPO plan).
Pretty sure Reps had nothing to do with the ACA, but go ahead and spin anyway..... like a top.
Everything above is my opinion....YMMV
While true, you ignore the fact that they started skyrocketing long before Obamacare was passed.
Healthcare costs have been rising world-wide. Obamacare marked a decrease in the rise for the USA.
And I agree with you on the middlemen. They're adding approximately 30% to the cost of our healthcare by themselves. Minimum.
I don't read AC A human right
No need to imagine. Lots of states have privately run DMVs for car title-related stuff now. You walk in, talk to someone immediately, hand over your paperwork, they help you with real customer service and then at the end of the 10 minute process they tack on a $6-8 extra "fee" for not having to wait several hours at the still existing government-run ones.
The party of stupid and the party of evil get together and do something both stupid and evil, then call it bipartisan.
The rich don't care.
Neither to the poor.
If you think I voted for Trump because of this post, you're wrong. I voted for Dr. Jill Stein of the Green Party. Again.
No. Obamacare DOUBLED the rate of increase for plans. My state had respectable individual plans that could not be canceled. Except Obamacare caused them to be canceled. Now the decent replacement plans look like they're going to be canceled and nothing will be left but total crap.
A Pirate and a Puritan look the same on a balance sheet.
Tell you what, never use our roads, our internet, our many other public services ever again. Shut yourself up in your private property hermitage, dig a well because you aren't allowed to use water that came from a river the government diverted for our benefit. We'll work out a list of products you can never use because they resulted from government backed research. Then.. yeah you can quit paying taxes then. We'll let you.
Why not set it up a la carte? See what public services people feel are worth paying their money for? It might actually get more rational public spending by pushing people to think about just where whatever public service they think would be cool and nifty to have will come from, especially since for things like 'community pool' you could have the trigger not be 'majority' but 'sufficient funding.'
It's very easy to vote for funding things such as a library, but my experience is that you're not going to be told where the money is actually going to be found. Yes, alright, sometimes you get told that they're going to issue bonds but I've gotten to watch politicians--some of whom are now nationally-known--give every reason to believe that they don't understand how bonds actually work. You sell them for money now and look confused when people want to redeem them at maturity because...apparently they were just supposed to turn into money somehow? It's hard to tell. (It got rather hard for the city and county this was in to get people to vote for bonds, because even the college students who weren't likely to be there long enough to see whatever it was built caught on.)
Replacing insurance companies with the federal government does not cut out the middleman, you idiot.
I worked for seven years in the medical insurance business (so glad to have left the field!) and the ignorance seen in many high-rated posts here is astounding.
1. GAO report, so no fraud
2. Even if someone wanted to fraudulently create an applicant, I don't see the problem, as long as they don't submit a claim. What's wrong w/ additional premium? (I will ignore the geeky underwriters, as I understand their position, but haven't seen any relevant objections so far about messing up the statistics.)
3. You cannot begin to appreciate the stupidity of pretty much everyone in the insurance business - so the inability to do very basic SSN validity checking comes as no surprise at all.
I left the year ACA came into effect, so got to experience the fun as we tried to implement insurance plans that Congress had not defined. See, ACA went into effect 2014, but we (that is, insurance companies) didn't have black letter law or even Federally-defined policies established (on many different fronts) until way past Jan 2014. How can you determine policies if underwriters don't know what the rules are???
Biut what continues to be under-reported is what a complete disaster/fail the back-office procedures are. Are we finally able to determine if someone is eligible? When I left, there was no way to tell if an applicant was qualfied for subsidies under the various arcane income rules.
If I were dictator, I'd immediately force hospitals and pharmaceutical companies to fall under the anti trust laws that everyone else has to follow. The high-deductible plans were created under the assumption that consumers would be motivited to shop around for the cheapest deal. But, it is impossible to get an actual quote for a procedure. If you require hospitals to produce a rate sheet that applies to all, and permitted people to import drugs from anywhere in the world, a massive amount of money could be saved.
But this cuts into rx profits, and we can't have that.
I hear that a lot but can never find where any vote in congress happened where republicans actually voted for it.
The reality is a lot different than the picture you attempt to paint. Outside of some republicans in very liberal states, very few supported it and the support it seems to have recieved was the lesser of two evils type. There are plenty of conservative states which republicans controlled all branches of government which refused to adopt similar laws or the law you claim they championed. It has never been brought to the floor of the house or Senate any recieved any significant amount of republican votes. During the primary, Romney got slammed hard for Romney care by republicans and democrats both. In fact, even the democrats had severe issues with the PPACA and it only passed by legislative maneuvering and bribes to democratic senators when the democrats controlled both houses of congress and the administration.
You really should look into what you are repeating before blindly repeating it. Perhaps doing a little sanity check on your reality would be wise to. It certainly doesn't match the pictures you painted which is likely why you find yourself "informing" people so often. The reason they didn't know is because it is made up or presented fictitiousaly.