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Affordable Care Act Reviews

OIG is focused on promoting the economy, efficiency, and effectiveness of Affordable Care Act (ACA) programs across HHS. We are conducting reviews of the health insurance marketplaces and related programs, as well as reviews of other health reform programs in Medicare, Medicaid, and the public health programs. Below is a consolidated list of reviews we have issued in these areas. It will be updated as new reviews are published.

Health Insurance Marketplaces

Report Title Issue Date Report Number
The Centers for Medicare & Medicaid Services Did Not Identify and Report Potential Antideficiency Act Violations for 12 Contracts Used To Establish the Federal Marketplace Under the Affordable Care Act 02-28-2020 (A-03-16-03001)
The Federal Marketplace Properly Determined Individuals' Eligibility for Enrollment in Qualified Health Plans but Improperly Determined That an Estimated 3 Percent of Individuals Were Eligible for Insurance Affordability Programs 02-07-2020 (A-09-18-01000)
CMS Did Not Always Accurately Authorize Financial Assistance Payments to Qualified Health Plan Issuers in Accordance With Federal Requirements During the 2014 Benefit Year 08-08-2018 (A-02-15-02013)
New York Did Not Comply With Federal Grant Requirements for Allocating and Claiming Marketplace Contract Costs 12-22-2017 (A-02-15-02008)
CMS Did Not Provide Effective Oversight To Ensure That State Marketplaces Always Properly Determined Individuals' Eligibility for Qualified Health Plans and Insurance Affordability Programs 09-25-2017 (A-09-16-01002)
CMS Oversight Must Continue Because All Remaining Consumer Operated and Oriented Plans Were Not Profitable and May Not Be Viable and Sustainable 08-25-2017 (A-05-16-00027)
Briefing to The Honorable Gus Bilirakis, Subcommittee on Health, Committee on Energy and Commerce, House of Representatives 05-08-2017 (A-02-17-02001)
Data Inadequacies Undermine CMS's Oversight of the Inconsistency Resolution Process for the Federal Marketplace 03-16-2017 (OEI-01-14-00620)
Kentucky Misallocated Millions to Establishment Grants for a Health Insurance Marketplace 02-02-2017 (A-04-14-07050)
Colorado Did Not Correctly Expend Establishment Grant Funds for Establishing a Health Insurance Marketplace 12-27-2016 (A-07-14-02801)
The Minnesota Marketplace Misallocated Federal Funds and Claimed Unallowable Costs 11-23-2016 (A-05-14-00045)
New York Misallocated Costs to Establishment Grants for a Health Insurance Marketplace 11-21-2016 (A-02-14-02017)
Public Summary Report: New York Implemented Security Controls Over Its Health Insurance Exchange Web Site and Database but Could Improve Security Controls 11-04-2016 (A-02-15-03001)
Public Summary Report: Information Technology Control Weaknesses Found at the Minnesota Health Insurance Exchange  09-26-2016 (A-06-15-00035)
Vermont Did Not Properly Allocate Millions to Establishment Grants for a Health Insurance Marketplace 09-23-2016 (A-01-15-02500)
Conversions of Startup Loans Into Surplus Notes by Consumer Operated and Oriented Plans Were Allowable but Not Always Effective 08-04-2016 (A-05-16-00019)
Public Summary Report: Washington State Implemented Security Controls Over the Web Site and Database for Its Health Insurance Exchange but Could Improve Protection of Personally Identifiable Information 06-01-2016 (A-09-15-03005)
Not All of the Vermont Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements 03-09-2016 (A-01-14-02507)
HealthCare.gov: Case Study of CMS Management of the Federal Marketplace 02-22-2016 (OEI-06-14-00350)
Not All of the District of Columbia Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements 02-22-2016 (A-03-14-03301)
Nevada Misallocated Costs for Establishing a Health Insurance Marketplace to Its Establishment Grants 02-17-2016 (A-09-14-01007)
Not All of the Minnesota Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements 02-12-2016 (A-05-14-00043)
Public Summary Report: Connect for Health Colorado Generally Protected Personally Identifiable Information on Its Health Insurance Exchange Web Sites and Databases but Could Continue To Improve Information Security Controls 02-10-2016 (A-07-15-00454)
Not All of the Washington Marketplace’s Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements 01-19-2016 (A-09-14-01006)
CMS Could Not Effectively Ensure That Advance Premium Tax Credit Payments Made Under the Affordable Care Act Were Only for Enrollees Who Paid Their Premiums 12-31-2015 (A-02-14-02025)
Not All of the Colorado Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements 12-28-2015 (A-07-14-03199)
The District of Columbia Claimed Allocated Costs to Its Establishment Grants in Accordance With Federal Requirements 11-04-2015 (A-03-14-03300)
The Kentucky Marketplace's Internal Controls Were Generally Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements 10-14-2015 (A-04-14-08036)
The Centers for Medicare and Medicaid Services' Implementation Of Security Controls Over the Multidimensional Insurance Data Analytics System Needs Improvement 09-21-2015 (A-06-14-00067)
Not All Internal Controls Implemented by the New York Marketplace Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements 09-21-2015 (A-02-14-02020)
CMS Did Not Identify All Federal Marketplace Contract Costs and Did Not Properly Validate the Amount To Withhold for Defect Resolution on the Principal Federal Marketplace Contrac 09-18-2015 (A-03-14-03002)
CMS Did Not Always Manage and Oversee Contractor Performance for the Federal Marketplace as Required by Federal Requirements and Contract Terms 09-14-2015 (A-03-14-03001)
Not All of the Federally Facilitated Marketplace's Internal Controls Were Effective in Ensuring That Individuals Were Properly Determined Eligible for Qualified Health Plans and Insurance Affordability Programs 08-06-2015 (A-09-14-01011)
Actual Enrollment and Profitability Was Lower Than Projections Made by the Consumer Operated and Oriented Plans and Might Affect Their Ability to Repay Loans Provided Under the Affordable Care Act 07-29-2015 (A-05-14-00055)
CMS's Internal Controls Did Not Effectively Ensure the Accuracy of Aggregate Financial Assistance Payments Made to Qualified Health Plan Issuers Under the Affordable Care Act 06-16-2015 (A-02-14-02006)
California Implemented Security Controls Over the Web Site and Databases for Its Health Insurance Exchange but Could Improve Protection of Personally Identifiable Information 04-30-2015 (A-09-14-03005)
Early Alert: Without Clearer Guidance, Marketplaces Might Use Federal Funding Assistance for Operational Costs When Prohibited by Law 04-27-2015 (A-01-14-02509)
Review of the Accounting Structure Used for the Administration of Premium Tax Credits 03-31-2015 (OEI-06-14-00590)
Maryland Misallocated Millions to Establishment Grants for a Health Insurance Marketplace 03-26-2015 (A-01-14-02503)
Federal Marketplace: Inadequacies in Contract Planning and Procurement 01-20-2015 (OEI-03-14-00230)
Health Insurance Marketplaces Generally Protected Personally Identifiable Information but Could Improve Certain Information Security Controls 09-22-2014 (A-18-14-30011)
An Overview of 60 Contracts That Contributed to the Development and Operation of the Federal Marketplace 08-26-2014 (OEI-03-14-00231)
Marketplaces Faced Early Challenges Resolving Inconsistencies With Applicant Data 07-02-2014 (OEI-01-14-00180)
Not All Internal Controls Implemented by the Federal, California, and Connecticut Marketplaces Were Effective in Ensuring That Individuals Were Enrolled in Qualified Health Plans According to Federal Requirements 06-30-2014 (A-09-14-01000)
Observations Noted During the OIG Review of CMS's Implementation of the Health Insurance Exchange-Data Services Hub 08-02-2013 (A-18-13-30070)
The Centers for Medicare & Medicaid Services Awarded Consumer Operated and Oriented Plan Program Loans in Accordance With Federal Requirements, and Continued Oversight Is Needed 07-30-2013 (A-05-12-00043)
Early Implementation of the Consumer Operated and Oriented Plan Loan Program 06-16-2013 (OEI-01-12-00290)

Other Affordable Care Act Reports

Report Title Issue Date Report Number
Corporaci�n Salud Asegurada por Nuestra Organizaci�n Solidaria, Inc., a Health Resources and Services Administration Grantee, Generally Complied With Federal Grant Requirements 11-29-2018 (A-02-17-02004)
Pennsylvania Generally Complied With Maternal, Infant, and Early Childhood Home Visiting Program Requirements 10-10-2018 (A-03-15-03300)
Illinois Did Not Always Comply With Maternal, Infant, and Early Childhood Home Visiting Program Requirements 07-24-2018 (A-05-16-00066)
Henry J. Austin Health Center, Inc., a Health Resources and Services Administration Grantee, Did Not Comply With Federal Grant Requirements 02-01-2018 (A-02-17-02002)
Indiana Did Not Always Comply With Maternal, Infant, and Early Childhood Home Visiting Program Requirements 12-22-2017 (A-05-16-00056)
Wisconsin Did Not Always Comply With Maternal, Infant, and Early Childhood Home Visiting Program Requirements 09-11-2017 (A-05-15-00049)
CMS Validated Hospital Inpatient Quality Reporting Program Data, But Should Use Additional Tools to Identify Gaming 05-01-2017 (OEI-01-15-00320)
Housing Works, Inc., Did Not Always Comply With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant 12-08-2016 (A-02-15-02001)
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2016 06-29-2016 (OEI-05-16-00090)
State Efforts to Exclude 340B Drugs from Medicaid Managed Care Rebates 06-07-2016 (OEI-05-14-00430)
Observations From Our Review of CMS's Administration of the First Performance Year of the Pioneer Accountable Care Organization Payment Model 05-31-2016 (A-01-13-00509)
Medicaid Enhanced Provider Enrollment Screenings Have Not Been Fully Implemented 05-20-2016 (OEI-05-13-00520)
Medicaid: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure 05-20-2016 (OEI-04-11-00590)
Medicare Vulnerabilities Related to Provider Enrollment and Ownership Disclosure 05-20-2016 (OEI-04-11-00591)
Enhanced Enrollment Screening of Medicare Providers: Early Implementation Results 04-27-2016 (OEI-03-13-00050)
Inconsistencies in State Implementation of Correct Coding Edits May Allow Improper Medicaid Payments 04-15-2016 (OEI-09-14-00440)
The Ohio Association of Foodbanks Generally Complied With the Navigator Requirements Related to the Affordable Care Act 04-05-2016 (A-05-15-00013)
HPM Foundation, Inc., Did Not Always Comply With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant 02-05-2016 (A-02-14-02022)
Hidalgo Medical Services Did Not Comply With All Federal Requirements Related to Its Capital Development Grant 01-25-2016 (A-06-14-00056)
National Background Check Program for Long-Term-Care Employees: Interim Report 01-19-2016 (OEI-07-10-00420)
North Carolina Department of Health and Human Services Did Not Always Claim Costs Under CDC Prevention and Public Health Fund Awards in Accordance with Federal Requirements 01-14-2016 (A-04-14-04028)
Arkansas Complied With the Requirements of the Affordable Care Act in Its Review of Cases of Credible Allegations of Medicaid Fraud 09-21-2015 (A-06-15-00026)
States' Collection of Rebates for Drugs Paid Through Medicaid Managed Care Organizations Has Improved 09-16-2015 (OEI-05-14-00431)
Washington State Did Not Suspend Medicaid Payments to Some Providers With Credible Allegations of Fraud in Accordance With the Affordable Care Act 08-31-2015 (A-09-14-02018)
Providers Did Not Always Reconcile Patient Records With Credit Balances and Report and Return the Associated Medicaid Overpayments to State Agencies 08-26-2015 (A-04-14-04029)
Community of Hope Generally Complied With the Requirements of a Capital Development Grant Funded Under the Affordable Care Act 08-18-2015 (A-03-14-03304)
Providers Terminated from One State Medicaid Program Continued Participating in Other States 08-04-2015 (OEI-06-12-00030)
Not All States Reported Medicaid Managed Care Encounter Data as Required 07-02-2015 (OEI-07-13-00120)
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2015 06-30-2015 (OEI-05-15-00120)
East Harlem Council for Human Services, Inc., Complied With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant 05-21-2015 (A-02-14-02021)
Chase Brexton Health Care Complied With the Requirements of a Community Health Center Grant Funded Under the Affordable Care Act 05-21-2015 (A-03-14-03303)
Medicaid Rebates for Brand-Name Drugs Exceeded Part D Rebates by a Substantial Margin 04-21-2015 (OEI-03-13-00650)
Lone Star Circle of Care Complied With Federal Requirements Related to Its Affordable Care Act-Funded Community Health Center Fund Grant 04-07-2015 (A-06-14-00058)
Ohio Did Not Always Comply With the Requirements of the Affordable Care Act in its Review of Cases of Credible Allegations of Medicaid Fraud 03-09-2015 (A-05-14-00008)
Medicare Hospices Have Financial Incentives To Provide Care in Assisted Living Facilities 01-13-2015 (OEI-02-14-00070)
States' Collection of Offset and Supplemental Medicaid Rebates 12-12-2014 (OEI-03-12-00520)
Minnesota Complied With the Requirements of the Affordable Care Act in its Review of Cases of Credible Allegations of Medicaid Fraud 11-21-2014 (A-05-14-00009)
Pennsylvania Complied With the Requirements of the Affordable Care Act in its Review of Cases of Credible Allegations of Medicaid Fraud 06-25-2014 (A-03-14-00202)
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2014 06-11-2014 (OEI-05-14-00170)
Annual Fee on Branded Prescription Drug Companies Under the Affordable Care Act 04-19-2014 (OEI-03-12-00560)
Kentucky Did Not Pay Some Line Items on Medicaid Claims in Accordance With Its Medicaid National Correct Coding Initiative Methodologies 02-05-2014 (A-04-13-06166)
Review of Jersey City Early Retiree Reinsurance Program 01-10-2014 (A-05-12-00039)
Georgia Did Not Pay Some Line Items on Medicaid Claims in Accordance With Its Medicaid National Correct Coding Initiative Methodologies 12-04-2013 A-04-12-06159
Arkansas Properly Reported the Affordable Care Act Portion of Medicaid Drug Rebates 10-21-2013 (A-06-13-00034)
Medicaid Drug Pricing in State Maximum Allowable Cost Programs 08-29-2013 (OEI-03-11-00640)
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2013 06-03-2013 (OEI-05-13-00090)
Oversight of Private Health Insurance Submissions to the HealthCare.gov Plan Finder 04-01-2013 (OEI-03-11-00560)
The UAW Retiree Medical Benefits Trust Properly Claimed Early Retiree Reinsurance Program Reimbursements 12-19-2012 (A-05-11-00108)
The Chicago Regional Council of Carpenters Welfare Fund Properly Claimed Early Retiree Reinsurance Program Reimbursements 12-19-2012 (A-05-11-00109)
Criminal Convictions for Nurse Aides With Substantiated Findings of Abuse, Neglect, and Misappropriation 10-05-2012 (OEI-07-10-00422)
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles: 2012 06-07-2012 (OEI-05-12-00060)
Part D Plans Generally Include Drugs Commonly Used by Dual Eligibles 05-26-2011 (OEI-05-10-00390)
Centers for Disease Control and Prevention Did Not Meet Program Expansion Supplement Requirements for Awarding One Affordable Care Act Grant 04-13-2012 (A-04-11-01003)

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