Oversight Report on Obamacare Enrollment Programs Reveals Risk of Fraud, Misinformation

September 18, 2013

Top HHS Officials Admit Navigator and Assister Programs are Targets for Identity Theft

WASHINGTON – The House Oversight and Government Reform Committee today released a new staff report on Obamacare’s Navigator and Assister programs, which includes admissions from top Health and Human Services officials that the program lacks basic safeguards against fraud and abuse.

The Navigator program was created by Obamacare as an outreach program to encourage and facilitate enrollment in health insurance exchanges. Navigators were intended to be funded using the state exchange’s operating funds. However, after several states expressed unwillingness to use their own resources to fund the program, the Administration created a twin program, called the In-Person Assistance Program (Assisters), which fulfills an identical function but uses federal funding. The Assisters program adds hundreds of millions of dollars in new spending without congressional approval.

The report also highlights the significant risk for fraud and abuse due to the lack of background checks for Navigators and Assisters and the inability of consumers to find out whether someone offering them assistance with ObamaCare is a trained and certified Navigator or Assister or a scam artist. It also shows that top HHS officials expressed concerns about the risk of scam artists and identity thieves, but did not place eligibility requirements on Navigators and Assisters that would prevent them.

Key Findings:

-          The Administration created the Assisters program without congressional approval: “HHS’s policy permitting states to then fund these de-facto Navigators from federal establishment grants rather than the exchange’s operational funds is not supported by the statute and thus spends substantial sums of unauthorized money on ObamaCare outreach.” [6-8]

-          Top HHS officials have admitted that the enrollment outreach programs are prime targets for fraud:  In her transcribed interview with Committee investigators, Vicki Gottlich, the top HHS official involved in the day-to-day implementation of Obamcare until July 2013, testified that she was concerned that people may pose as Navigators to try to take consumer information. [15]

-          Consumers have no way to verify that someone taking their application or encouraging enrollment is actually a Navigator or Assister: “[B]ecause HHS will not maintain a list of names of certified Navigator and Assister personnel, [Ms. Gottlich] admitted that there is no way for consumers to verify whether a person is affiliated with a legitimate organization. In fact, HHS will be unable to confirm if the individual contacting the consumer is a legitimate Navigator or Assister for consumers who call the HHS hotline recommended on the HHS Consumer Information Sheet… CMS contemplated creating a list of all individuals certified and authenticated as Navigators and Assisters but ultimately decided not to create such a list.” [14-16]

-          HHS officials were concerned about security risks, but did not look into whether or not they could require background checks: “Ms. Gottlich also testified that HHS did not discuss requiring background checks prior to the proposed rule and the issue being raised by Committee staff in April 2013 and that HHS never considered banning convicted felons or individuals convicted of identity theft from being Navigators or Assisters.” [9-14]

-          HHS has criticized direct phone calls, door-to-door solicitation, but has not banned them: “When asked about these two practices, Ms. Gottlich assured Committee staff that neither type of activity would be performed by Navigators or Assister…. Despite Ms. Gottlich’s repeated insistence that Navigators and Assisters would not be allowed to canvass door-to-door, make unsolicited phone calls, or send unsolicited emails, HHS’s Consumer Information Sheet failed to include this information.” [17-19]

-          In some states, Navigators and Assisters are paid based on the number of persons they enroll, creating a conflict of interest: “With this kind of pay structure, Navigators and Assisters have a financial incentive to persuade people to enroll. Ms. Gottlich admitted that paying Navigators for each person they enroll could lead Navigators and Assisters to cross the line from simply ‘facilitating’ enrollment, to persuading persons to enroll and/or actually enrolling them.” [21-23]

You can read the report here.

 

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