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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."

14 of 246 comments (clear)

  1. Re:So make sure they all get jailed for fraud by ShanghaiBill · · Score: 4, Insightful

    I'm sure submitting false information on those forms is illegal.

    Why should it be illegal? If you want to buy insurance for someone that doesn't exist, that is fine with me.

  2. All entitlement programs are rife with trust/fraud by rmdingler · · Score: 4, Interesting
    Judging by the frequency with which the courts around here have a "Tampering With Gov't Records" case before them, I would venture a guess this sort of lie for profit is universally problematic for assistance programs.

    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

  3. Arrest the GAO? by cirby · · Score: 4, Insightful

    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.

  4. Re:So make sure they all get jailed for fraud by ScentCone · · Score: 4, Insightful

    Why should it be illegal? If you want to buy insurance for someone that doesn't exist, that is fine with me.

    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.

    --
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  5. Re:So make sure they all get jailed for fraud by hawguy · · Score: 4, Insightful

    I'm sure submitting false information on those forms is illegal.

    Why should it be illegal? If you want to buy insurance for someone that doesn't exist, that is fine with me.

    But are you ok with them submitting and getting paid for claims for that fictitious person? Buying insurance for a fictitious person should be as illegal as submitting claims for them, so if you find that someone has bought 1000 policies for fictitious people, you have a tool to stop them before they start submitting claims.

  6. Re:Affordable my ass by HiThere · · Score: 3, Informative

    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.
  7. Only Trust by SuperKendall · · Score: 4, Insightful

    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
  8. Re:So what? by Ritz_Just_Ritz · · Score: 3, Insightful

    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.

  9. Easy answer by rsilvergun · · Score: 4, Insightful

    Single payer. Book it done.

    --
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  10. an insurance is just paper... by jopsen · · Score: 4, Insightful

    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).

  11. Re: The Republicans... by Papaspud · · Score: 3, Insightful

    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
  12. Re:So make sure they all get jailed for fraud by jedidiah · · Score: 4, Insightful

    Forget about illegal. The system couldn't even figure out that the details were completely invalid and fictitious. It's unable to do the slightest bit of basic sanity checking.

    --
    A Pirate and a Puritan look the same on a balance sheet.
  13. Re:So make sure they all get jailed for fraud by khallow · · Score: 3, Informative

    Why should it be illegal? If you want to buy insurance for someone that doesn't exist, that is fine with me.

    Consider this scenario:
    1) Create a pile of fake people.
    2) Conspirator at insurance company gets them insurance.
    3) Siphon money out of the company as commission bonuses.

    If instead, you control the insurance company, then you can rake in the subsidies. Fake low income people, subsidized by Uncle Sugar, who never need medical care would be great for the bottom line.

  14. Re: The Republicans... by sumdumass · · Score: 3, Insightful

    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.