OIG Report: HealthCare.gov Still Lacks Automated Financial Back End

June 18, 2015 in News

After two periods of open enrollment under the Affordable Care Act, HealthCare.gov still does not have an automated financial back end, according to a new report by the HHS Office of Inspector General, FCW reports.


When HealthCare.gov launched, it lacked reconciliation functions.

As a result, CMS used non-automated processes to complete advanced payments for premium subsidies to insurance companies. The payments are determined by estimated costs and enrollment figures reported by insurers.  

OIG Report Findings

The new OIG report examined the financial reconciliation process for payments to insurers from January 2014 to April 2014.

OIG found that internal controls to check for payment errors were “not effective,” FCW reports.

Further, OIG indicated that up to $2.8 billion in carrier payments were “at risk” because of ineffective controls.

The report identified just $314,000 in underpayments for reductions. However, it also noted that OIG was unable to confirm that any payments were made correctly because there was no system in place for verifying enrollment numbers.

OIG suggested that CMS implement technology to automate enrollment verification and payment processing.


In response to the report, CMS acting Administrator Andy Slavitt said, “While CMS lacks fully automated payment systems, it has implemented a rigorous and effective set of internal controls to make accurate payments.”

In addition, CMS has said it is piloting a process that would calculate enrollment directly from the HealthCare.gov system. However, it still would use insurer verification because insurers are able to determine whether enrollees have paid their premiums.

CMS has said it plans to implement this year a permanent process for paying carriers using individual enrollment data (Mazmanian, FCW, 6/17).

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