Fraud watchdog: Health law sign-ups dogged by data discrepancies

WASHINGTON — The Obama administration has been struggling to clear up data discrepancies that could potentially jeopardize coverage for millions under the health overhaul, the government's health care fraud watchdog reported Tuesday.

The Health and Human Services inspector general said the administration was not able to resolve 2.6 million so-called "inconsistencies" out of a total of 2.9 million such problems in the federal insurance exchange from October through December 2013.

Of the roughly 330,000 cases that could be straightened out, the administration had only actually resolved about 10,000 during the period of the inspector general's audit. That worked out to less than 1 percent of the total.

Several states running their own insurance markets also were having problems clearing up data discrepancies.

Most of the issues dealt with citizenship and income information supplied by consumers that conflicted with what the federal government has on record, the report said.

It marked the first independent look at a festering behind-the-scenes issue that could turn into another health law headache for the White House.

President Barack Obama celebrated 8 million sign-ups as proof that technical problems which initially kept many consumers from enrolling had finally been overcome. It now turns out that some of those problems continued out of sight. The inspector general said the efforts of the administration and states to clear up the discrepancies were complicated by lingering computer issues.

"The federal marketplace was generally incapable of resolving most inconsistencies," the report said.

The issue is one of the top challenges facing newly installed HHS Secretary Sylvia Mathews Burwell.

The report was requested by congressional Republicans as a condition of ending the budget standoff that shut down the government last fall. Republicans say they are concerned that people who are not legally entitled to the law's government-subsidized private health insurance could nonetheless be getting it.

The inspector general stopped short of drawing such conclusions.

"Inconsistencies do not necessarily indicate that an applicant provided inaccurate information ... or is receiving financial assistance through insurance affordability programs inappropriately," the report said.

However, the watchdog office called on the administration to publicly explain how and by what date it will resolve the data problems in the 36 states where Washington is operating new insurance markets.

In a written response to the report, Medicare chief Marilyn Tavenner said the administration concurs with the recommendations and is working on a plan. Tavenner also said that some of the computer issues that were getting in the way of resolving the problems have now been overcome.

"It is not surprising that there are inconsistencies between some information provided by application filers and the (government's) electronic data sources," she said.

The law provides the administration with the option of extending an initial 90-day period for clearing up discrepancies.

The inspector general also found that:

— Early on, the government's eligibility system was "not fully operational." As a consequence, even if a consumer supplied the appropriate documentation, officials were not able to close the case.

—States running their own insurance markets had a mixed record of dealing with eligibility problems. Of the 15 — including Washington, D.C. — seven said they cleared up problems without delay. Four said they were unable to resolve inconsistencies. Some did not supply any information.

— Most of the data discrepancies in the federal market had to do with citizenship and immigration status. Only citizens and legal immigrants can receive coverage under the law. More than 40 percent of the problems involved citizenship and immigration information. Income was the next category, accounting for one-third of the problems.