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Audit Finds Deficiencies in New York State’s Health Insurance Exchange

Wall Street Journal (09/23/15) Stephanie Armour

The inspector general for the U.S. Department of Health and Human Services has concluded that some controls that New York state relied on to make sure people were eligible for health-insurance coverage and subsidies on the state-run exchange were deficient, potentially letting some consumers get benefits to which they were not entitled. The inspector general earlier found similar issues in its probe of the federal exchange, It has turned its focus to audits of some of the more than a dozen state exchanges, with New York’s findings the first to be released. Other exchanges being audited include those in Colorado, Kentucky, Minnesota, Vermont, Washington state, and the District of Columbia.

New York officials have taken corrective steps, according to responses by state officials included in the inspector general’s report. “We would like to clarify that system functions or modifications to address each of the identified issues were already implemented or developed prior to the audit,” the New York State Department of Health wrote in its response. The exchange’s controls weren’t always effective in verifying household income, resolving inconsistencies in eligibility data, and making sure programs were approved only for consumers who don’t have employer-provided insurance, according to the inspector general’s report.