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GAO: Improper Payments: Improvements Needed in CMS and IRS Controls over Health Insurance Premium Tax Credit

July 1, 2017

Pursuit's Take

In fiscal year 2016, the Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services (CMS) assessed its advance premium tax credit (PTC) program as susceptible to significant improper payments. CMS instituted a qualitative method for assessing the susceptibility of its program that was consistent with requirements, including assessing each of the nine required qualitative risk factors. However, CMS stated that it may not report improper payment estimates for the PTC program as required until at least fiscal year 2022 because of the complexity and timing of the process for developing such estimates. As a result, HHS’s overall improper payments estimate will continue to be understated, and Congress and others will continue to lack key payment integrity information for monitoring HHS’s improper payments.

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