NEW: Vance Announces Massive Crackdown On Obamacare Fraud

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Vice President JD Vance announced Tuesday that the Trump Administration would stop enrollment in Affordable Care Act marketplace plans, commonly referred to as Obamacare, for about 750,000 people the government determined were fraudulently enrolled.

The announcement came during a news conference at the Eisenhower Executive Office Building on the White House campus. Vance, who chairs the White House Task Force to Eliminate Fraud and was appointed the administration’s fraud czar earlier in the year, said the action would save an estimated $2.2 billion in federal subsidies.

“We are stopping Obamacare enrollment for about 750,000 people who we believe are fraudulently enrolled in the program,” Vance said. He described the group as individuals the administration felt confident “either don’t know that they’re enrolled in the program, aren’t using the program at all, are unaware of it, or … are potentially phantom people.”


Some, he added, were likely “enrolled against their will” or “maybe they don’t even exist — it’s just a person who exists on paper who was created to defraud the American taxpayer.”

The Centers for Medicare and Medicaid Services stated separately that it had canceled approximately 315,000 unauthorized enrollments covering more than 760,000 individuals. Officials identified many of the cases through a lack of medical claims, failure to respond to multiple contact attempts including letters and other methods, missing Social Security numbers or immigration documents, or other eligibility discrepancies.

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CMS Administrator Dr. Mehmet Oz said some enrollees never filed a claim for a doctor’s visit or filled a prescription. He noted that a portion of marketplace enrollees historically do not use services, but the rate observed here exceeded typical patterns.

Vance also announced additional verification for about 419,000 other enrollees. “The second thing that we’re going to do is we’re going to do some additional verification. We expect that most of these people are fraudulently enrolled, but we’re going to do some additional verification on about 419,000 people,” he said. “We’re going to make sure that they’re first of all legal residents of the United States of America and second of all we’re going to make sure that they actually meet the income threshold requirements in order to receive these Obamacare benefits.”

Eligibility for subsidies generally requires income between one and four times the federal poverty level, verified in part through tax information.

In addition, Oz announced a temporary national moratorium on new brokers and agents selling marketplace plans, which will last for six months.

“There will be no new brokers for Obamacare in this country for the next six months,” Oz said. “Most of the fraud, a disproportionate amount of fraud, is taking place from these individuals.” CMS had already removed some agents from the system and planned further terminations. Officials said brokers receive commissions for enrollments, creating incentives that the administration linked to improper sign-ups, including cases in which people were enrolled without their knowledge.

Vance cited one example of a fraud ring involving 40 brokerage agents who funneled 50,000 people into the system. “In one case we found a fraud ring that had 40 agents, 40 brokerage agents who had funneled 50,000 people into the Obamacare system fraudulently. Now, some of those people were probably legitimate. Most of those people were not eligible (because) either they didn’t meet the citizenship or the income requirements. Many of those people quite literally didn’t even exist,” he said.

The vice president described the prior approach as creating a system that “rewarded brokers that made people rich for enrolling fake people in programs that are meant to ensure that our fellow citizens have health care. This was a scandal.”

Vance attributed much of the issue to earlier policy choices that combined broker incentives with reduced verification. “You have a system where, on the one hand, brokers are paid money to feed patients into the system, while on the other hand, the government isn’t even checking whether the people enrolled are actually eligible for the program. What do you have? Of course—rampant, rampant fraud,” he added.

“We’re actually making sure that the people receiving Obamacare subsidies are actually entitled to receive them. Amazingly we weren’t doing that before.” He placed the $2.2 billion figure in context by noting that the average American child receives about $4,000 in health care benefits annually, equating the savings to coverage for 550,000 children.

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Source
Las Vegas News Magazine

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