Burwell: HHS Not Aware of Any Fraud in Federal Insurance Exchange

July 30, 2015 in News

On Tuesday, HHS Secretary Sylvia Mathews Burwell testified before Congress that her department has no evidence of consumers fraudulently obtaining coverage through the federal online health insurance exchange, Modern Healthcare reports (Dickson, Modern Healthcare, 7/28).


A Government Accountability Office report released  this month found that the federal exchange automatically re-enrolled 11 fake U.S. residents in health plans for 2015, despite ongoing documentation issues with the staged individuals. The initial investigation discovered that GAO officials were able to obtain subsidized coverage for fake applicants in 11 out of 12 applications submitted through HealthCare.gov’s website or the telephone.

A GAO official said during a hearing earlier this month that the agency did not find any proof of an individual fraudulently enrolled in federal exchange coverage outside of their investigation (iHealthBeat, 7/17).

Details of Burwell’s Testimony During a House Education and the Workforce Committee hearing, Burwell said GAO’s investigation is “the only examples (of fraud) that we know of.” 

According to Burwell, in the first quarter of this year HHS removed 117,000 people from the federal exchange and reduced the subsidies of thousands more after they were unable to verify their submitted information. Burwell could not say if any of those individuals were attempting to defraud the system. Further, Burwell said GAO has not issued recommendations to HHS regarding the results of its investigation.

Meanwhile, Senate Finance Committee Chair Orrin Hatch (R-Utah) in a letter to CMS acting Administrator Andy Slavitt requested details on data verification processes for the exchanges (Modern Healthcare, 7/28).

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