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Life Health > Health Insurance > Health Insurance

House Oversight blasts exchange helper incentives

By Allison Bell

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A House committee is accusing managers of the new public exchange program of encouraging enrollers to use biased information to hype the program.

Holes in enroller compensation rules “raise the risk of massive fraudulent spending on Medicaid and exchange subsidies for individuals who do not meet the eligibility requirements,” committee staffers say.

The staff of the House Oversight and Government Reform Committee make their case in a report on the risk of fraud at the public exchange outreach campaign.

Rep. Darrell Issa, R-chairman of the committee, had his staff look at U.S. Department of Health and Human Services (HHS) efforts to set up the Patient Protection and Affordable Care Act (PPACA) exchange navigator and “in-person assister” programs.

PPACA requires each state’s exchange to offer consumers “navigators,” or independent ombudsmen, to help the consumers understand how to use the exchanges. The Center for Consumer Information and Insurance Oversight (CCIIO), the arm of HHS running the exchange program, also has created a similar but separate “in-person assister” program.

House Oversight staffers say CCIIO set up the assister program to get around a PPACA provision that requires states to pay for their navigators with their own money. In the District of Columbia, for the example, the exchange expects to spend $100,000 in local money on navigators and $35 million in federal money on assisters.

The committee staffers say CCIIO is creating an opening for con artists to pretend to be exchange enrollers by failing to create an enroller database or giving the enrollers official badges.

Even the official enrollers may go to work with less than 20 hours of training, and no independent entity has had any oversight over the content of the training or the information the enrollers will be giving out, the staffers say.

CCIIO will be letting navigator and assister programs at state-based exchanges pay employees based on enrollment volume, without imposing any requirement that the enrollers tell consumers about the volume-based pay, the staffers say.

Gary Cohen, the CCIIO director, told the staffers in an interview that exchange enrollers will give consumers information about the small value of the PPACA individual coverage mandate violation mandate penalty, and exceptions to the individual coverage ownership requirements, only if consumers ask for that information.

The compensation rules, and the lack of emphasis on giving consumers clear information about mandate exceptions, mean that enrollers may fail to give consumers the information they need to know how to reconcile PPACA requirements with their own needs, the committee staffers say.

Also in the report, the staffers note that the press already has covered one major exchange-related data security incident.

In Minnesota, the staffers say, an exchange employee accidentally released a confidential document that included the Social Security numbers of 2,400 insurance brokers.

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