Skip to content

“It’s Time to Close the Floodgates On Fraud” – Brady, Upton, and Hatch On New Watchdog Report

December 15, 2016

WASHINGTON, D.C. – House Ways and Means Committee Chairman Kevin Brady (R-TX), House Energy and Commerce Committee Chairman Fred Upton (R-MI), and Senate Finance Committee Chairman Orrin Hatch (R-UT) today highlighted a new report from the non-partisan Government Accountability Office (GAO) detailing the significant gaps in verifying consumers accessing Special Enrollment Periods (SEPs).

Obamacare requires all federal and state-based marketplaces verify application information to determine eligibility for a health care plan. SEPs are generally used by patients who may lose health insurance outside of the traditional Open Enrollment Period (OEP) or experience a life event—like moving, having or adopting a child, or getting married. In the past, SEPs have granted individuals presumptive eligibility instead of verified eligibility, leading to risk imbalance and potential misuse.

The GAO’s report summarizes their findings, saying, “The federal and selected state-based marketplaces approved health-insurance coverage and subsidies for 9 of 12 of GAO’s fictitious applications made during a 2016 SEP.”

While the GAO makes no new recommendations in their report, the Obama administration has taken incremental steps to help avoid misuse or abuse of SEPs. But Republican lawmakers have urged the Administration through a series of congressional hearings and bills to require pre-enrollment verification for all individuals.

“This report confirms what we’ve known all along: Bad actors are taking advantage of loose enforcement mechanisms to access highly-subsidized health care plans,” said Chairmen Brady, Upton, and Hatch. “We’re encouraged that the Administration has acknowledged the verification gaps, but their actions don’t go far enough to protect taxpayers and stabilize markets. It’s time to close the floodgates on fraud.”

The GAO report was requested by Chairmen Brady, Upton, and Hatch. Yesterday, the Obama Administration took its latest steps to improve SEP safeguards, releasing the timeline for a pre-enrollment verification pilot program to begin Summer of 2017.

CLICK HERE to read the GAO report.