The House Oversight and Government Reform Committee has released a staff report stating the Patient Protection and Affordable Care Act navigator and in-person assistance programs lack basic safeguards against fraud and abuse.
The navigators and in-person assisters will perform informational services for Americans who need assistance in shopping for and enrolling in plans this fall. The difference between the two programs is navigator programs must be funded as part of the state exchange operations, although planning and start-up costs can be financed through federal grants. Assister programs can be funded entirely through federal exchange grants for the first year of exchange operations.
The report claims top HHS officials have admitted the enrollment outreach efforts will put insurance consumers at risk for fraud and identity theft. According to the report, Vicki Gottlich — a top HHS official involved in the day-to-day implementation of the healthcare reform law through July — told committee investigators she was concerned people may pose as navigators in order to take consumers' personal information.
Additionally, Ms. Gottlich told investigators there's no way for consumers to verify a person's identity as a certified navigator or assister because CMS opted not to make a list of all individuals authenticated as navigators and assisters. Ms. Gottlich also said HHS did not discuss requiring background checks and never considered banning convicted felons or people convicted of identity theft from performing outreach efforts through the programs.
Furthermore, HHS hasn't banned navigators and assisters from canvassing door-to-door, making unsolicited phone calls and sending unsolicited emails in an attempt to sign people up for insurance coverage, according to the report. Ms. Gottlich also told the committee that navigators and assisters will receive payment based on the number of people they enroll in some states, creating a conflict of interest. Ms. Gottlich currently serves as the consumer support group director at the CMS Center for Consumer Information and Insurance Oversight.
Finally, the report states HHS created the assisters program without Congressional approval. Because the in-person assistance programs aren't included in the PPACA, it constitutes the spending of substantial sums of "unauthorized" money, according to the committee.
Last month, HHS distributed $67 million in federal funds to navigator groups and organizations to help them perform outreach efforts. The navigator program has become the target of increasing scrutiny from Republican lawmakers and state officials. Members of the House of Representatives Committee on Energy and Commerce have asked the navigators for information on how they plan to spend $67 million in federal grants. Navigator groups have responded to the requests with offense and have said the committee's demands could hurt hiring and training efforts.
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