Recommendations, and theyre in the process of doing them. Thats correct. We had informal discussions as well as the formal letter responding to our recommendations. Thank you, mr. Chairman. Thank you, mr. Chairman. I want to thank our two witnesses. Lord knows where we would be if we didnt have gao and Inspector Generals. The alarming malfeasance and incompetence of the rollout of this plan is just stunning. And here we are, you know, we cant just simply brush it off and say, well, this was a bad start, but everythings going great now. The cost to the taxpayer probably well never know. But thank goodness that we have your organizations providing us information and spurring on a seemingly bureaucratic nightmare that exists within the federal government in terms of handling these kinds of programs. Anybody in the private sector that had done this would have been bankrupt. Investors would have lost all their money. Its just stunning to continue to observe what it takes to get these agencies to i think theyre well intended. Its just overwhelmed in terms of the complexity of getting this done. I go to the floor of the senate every week and talk about waste of the week. And mr. Bagdoyan did i pronounce that right, bagdoyan . Ive referenced your name, not as a part of the problem, but as part of the solution. And the information that youve provided here for me continues to stun people when they hear about some of the incompetencies. I was particularly interested because i think it speaks to a bigger problem, was your, what was called the secret shopper, where you deliberately made applications as a test. You made applications for compliance with the Affordable Care act and received in subsidies. And 11 of the 12 i think my numbers are right everything you submitted was fraudulent, but 11 of the 12 were accepted. And even after it was even after it was revealed that it was accepted, followup phone calls pretending to be that person who is given notice that they were not eligible were accepted. That percentage is pretty high. And if you multiply that out, it just really makes you wonder if just the whole thing wasnt gamed, or at least so intent on providing numbers to make it look successful that we really werent getting the information the verification that we needed. And then there was the question with cms at one point releasing a statement well, were not in the verification business. I think, basically, on what youve just said, that they are now taking a different stand on that. But i wonder if you could respond to where are we now in terms of verification capacities so that we dont have this fraudulent and wasteful situation moving on . Im happy to have either one of you or both of you address that. But this Social Security it just seems easy that, you know, an evaluation of Social Security numbers to determine their validity would make it fairly easy to make a determination as to whether they qualified or whether they didnt qualify. But then where is cms in terms of putting that process in place, and what is the success to date of that process . Sure, if i may, ms. Bliss, take first crack of that, on that. First, i appreciate the plug on the floor, senator. Sure. Keep sending the stuff, ill keep going to the floor. So, in terms of where cms is with the controls, what we call the control environment, which is a series of controls designed to verify information and identify potential indicators of fraud and so forth. As our undercover work indicated, both for 2014 and 2015 where we were equally successful, there is a semblance of controls in place a semblance . A semblance of controls in place, some basic things in place, like identityproofing, the document reconciliation process to clear inconsistencies, for example. But in each case, we were able to work around those reasonably easily and obtain coverage, both for 2014 and 2015. So, the vulnerabilities are still in place. Now, with the recommendations we made in this report, actually in late february, we made eight recommendations, as i explained to senator stabenow. The big one is to perform a comprehensive risk assessment. Now, thats going to take time, its going to take time for cms to absorb the results and then craft, hopefully, appropriate solutions for the future. So, this is a longterm proposition. Its not going to be an easy fix. Well, i think this speaks to the point that we got a bad start and everythings going great right now. Everythings not going great right now. There are major as you said, this is going to take a longterm effort to try to put these verification procedures in place and to be able to say that we are successfully avoiding fraud and waste at an inefficiency and taxpayer cost level that is just absolutely astounding. So, due respect to my colleagues, to tout this as something that has happened in the past but is corrected now and were sailing into the bright future, i think weve got a lot of work to do. Thanks, mr. Chairman. Thank you, mr. Chairman. And i want to again say that we said the initial rollout was botch botched and appreciated the Inspector General making it clear that a couple months in there was serious progress. So, you all reported that after the first open enrollment you said the agency demonstrated a strong sense of urgency to take action, accepted new work processes, and they improved the healthcare. Gov website substantially within two months. I think itd be helpful, ms. Bliss, if you could tell us two things what were the operational and strategic changes that were made after that first open, you know, enrollment, and do you feel theyre better equipped to deal with the challenge now . Thank you, Ranking Member wyden, for that question. As we discussed in the case study, some of the key strategic and operational changes that were made as part of the correction were to, one, establish more clear leadership and designate roles and responsibilities. And this time, they did it in a way that brought together staff and contractors across all of the important business lines that were affected and needed to be involved in the correction. That included the policy people, the technical, the communications and the contractors all coming together. With the influx of experts from across government and the private sector, there was the potential that it could have become more chaotic, but in fact, we saw that the reverse was true. It was well organized, folks were working together in a badgeless culture as a team, there was better communication, there was better measurement and monitoring of problems and progress in order to apply solutions more quickly and effectively. So, in effect, after the first few months, which everybody has acknowledged were not ideal, your characterization was essentially well organized . It was much better organized. And they continue to make progress. How would you word it . Okay, good. Mr. Bagdoyan, first, im probably the biggest users of gao products here in the congress. I so admire the professionalism of the agency. And i think you heard me say i dont take a back seat to anybody when it comes to cracking down on actual, realworld fraud. And my question to you is, isnt it correct that when you testified before the Committee Last year, you stated that the secret shopper investigation failed to uncover a single realworld example of fraud . Yes, thats what i said, senator wyden, and i would also couch that very carefully for you and the committee. The intent of that investigation was not to uncover fraud but to flag control vulnerabilities as well as identify indicators of potential fraud, which i think we did quite successfully. So, i just want to make clear, my charge is not to find fraud. Fraud is determined through a separate criminal proceeding in court to definitively determine that. So, my job, again, is to look for vulnerabilities in controls as well as identify indicators of potential fraud or improper payments. So, lets go then from last year when there was not one single, realworld example of fraud to where we are now. Is it correct to say that the entire investigation failed to identify any actual fraud . Well, again, i would refer you to my answer. That was not our intent. So, if im not looking for fraud, im not going to find it. What i am looking for is vulnerabilities in controls and indicators of potential fraud, such as the inconsistencies with the Social Security numbers, as well as in the case of the irs, 1. 3 Million People having potential i. D. Theft issues, which is a significant red flag. And i think that as is always the case, you all are right to talk about various issues that ought to be part of the debate. Thats not whats going on here. What people are saying is this is fraud. Fraud, fraud, fraud. And i appreciate your taking us through this in, i think, better balanced view. Ms. Bliss, hhs, you all do audits. Oig does audits. Have you uncovered in connection with this any confirmed cases of fraud . No, we have not had any cases that have resulted in criminal convictions or civil settlements to date. We do have a few investigations that are ongoing, and i cant predict what those outcomes will be. And you know, look, i dont know how many times ive said in this committee that when there are big, important issues and certainly, the Affordable Care act is right at the top of it we need to work in a bipartisan fashion, and there isnt a program anywhere in government that you cant find opportunities to Work Together and be bipartisan. I ticked off a number of them the chairman and i working together on what i think is the future of the medicare program, chronic care, senator grassley and i finishing what i think is a blockbuster study looking at hepatitisc, and it raises the question of when we have cures, will people be able to afford them . What i think is important is that to do bipartisan work, weve got to move away from, first the past, because everybody has acknowledged that the first few months were botched. I dont know how many times you can say it, but you all and i read your comment after the first few months, you said they had made substantial improvements. I think i can come back to it, and perhaps read it, you know, one more time. Center for Medicare Services recovered the Health Care Government website for High Consumer use within two months. Now, thats the new news. Thats just a few weeks old. Thats the new news. And i want people to hear that and i want people to hear that there were no actual, realworld cases of fraud uncovered. Now, one final question, if i might, for you, ms. Bliss. Do you disagree with the statement that i made with respect to the accomplishments of the Affordable Care act . That is not your formal role as Inspector General, but does anything strike you as being inaccurate there with respect to the uninsured rate or anything of that nature . As an independent oversight agency, we dont take positions on whether particular programs should exist, but we look to make sure theyre operating correctly, yes. The question was about the fac facts. And what i think, again, is this is a hard fact thats not in dispute, that the uninsured rate is now at or near the lowest level recorded across five decades of data with about 20 million previously uninsured americans gaining coverage since the acts provisions went into effect. So, ill keep the record open so that if you or your agency has any information suggesting thats wrong, id sure like to know about it, okay . Thank you. I dont have any information suggesting that thats wrong. Wonderful. Mr. Chairman, thank you. Senator scott . Ms. Bliss, do you have any information suggesting that those numbers are right . I cannot validate those numbers. I dont have any reason to believe theyre not. But you have no indication either way, actually. I have no basis for knowing. So, if i tell you the numbers 30 million, you have no reason to believe that its not 30 million. I dont have a basis for validating that number. Our case study did note thats great. Mr. Bagdoyan, our Ranking Member asked you several questions about fraud, and i certainly understand and appreciate why so Many Americans look at this process and become disenchanted. Your objective was never to figure out how much fraud was in the system, your objective, it appeared to me, to be to show us how fraud would be could happen. Is that accurate . Yeah, essentially, senator, youre correct. The big picture were looking at is any vulnerabilities in the controls that are in place and also for any indicators of potential fraud that pop up. For example, our ability to circumvent the controls we encountered during our undercover work. We did that for 2014, and we repeated that experience in 2015, which case we were successful 17 out of 18 attempts. Now, i would have to caution that, of course, further to the point that senator coates made earlier, that is not a projectable number. Yes. So, we have to be very careful that that doesnt represent the actual universe. That is just a data set that we used to continue our work in this area. Yes. Thank you very much. No ones going to mistake me for a fan of obamacare or the aca, without any question, for a number of reasons. Im not a fan of the website nor the actual policy itself, the legislation. I think of the independent payment advisory board, which some have referred to as death panel, the ability to ration care into the future, this is one of the classic examples of why so few americans have the same appreciation that others have talked about of the aca. Think about the fact that were talking about taxing americans, whether its their income or their profits, an additional 3. 8 tax, raising somewhere over 120 billion. Another reason why so few americans have the same positive opinion that weve heard from some of our friends on the other side. Think about the whole notion of how the Health Care Law is going to regulate the posting of calories at pizza parlors, grocery stores, all over the place, and by default, increasing the price of these groceries, these pizzas, and other nonfood items. Reducing the number of employees hours, talking about the impact on middleincome america. So Many Americans losing, perhaps up to 25 of their income because of the aca. We can see why as so Many Americans have found themselves frustrated with where we are with the aca that its not old news to them. Its not old news, actually, when you think about the fact that so Many Americans are facing higher premiums. Weve heard so many different numbers this morning. We know that at least some states have seen an increase of more than 25 of their health care cost. Two states have seen those numbers go over 35 . Those are real dollars for struggling americans who cannot afford the cost of health insurance. And not only are the premiums higher, the deductibles are higher, the outofpocket expenses are higher. The only thing thats actually lower are the doctors to choose from and the hospitals to go to. Weve seen a catastrophic occurrence under this Health Care Law. And even at one of the most recent democrat town halls, a young lady who supported president obama, who supports the Health Care Law, said that her premiums have doubled, tripled. Her concerns were strong, clear. Heres one real case example that ms. Bliss, i hope this is no longer happening. A young man named tom duguele from elgin, south carolina, who created an account on healthcare. Gov was called shortly thereafter by a man named mr. Dugel, from a guy named Justin Hadley from north carolina, who had done the exact same thing, gone online to healthcare. Gov and created an account. But what he found populating his account was information from mr. Dugle. He called hhs and could not get any assistance. Finally, they called our office, and during one of the hearings, we were able to get that situation solved, or at least the beginning of that situation solved. Can you guarantee me that that situation is no longer occurring anywhere within healthcare. Gov . I cannot guarantee that. Weve overseen and conducted reviews of the controls to ensure that both the website and other parts of the program and iden verification, knowledge verification are working properly, but we have raised concerns about some flaws or weaknesses in those controls, similar to gao, and i cant make that guarantee, but were certainly working hard to identify where theres a vulnerability of that happening and make recommendations on how to improve it. My last question, since im out of time so quickly here today, back to you, ms. Bliss, is that it appeared that, as we have celebrated the success of improving the system in the first couple of months, i will note a new 1 trillion program, one of the recommendations was for clear leadership. Earthshattering. Thank you. Senator isakson. Thank you, mr. Chairman, and i apologize for missing your testimony and i apologize for being late, but i do have one question based on a letter that i have sent previously to cms, and i want to ask this question to mr. Bagdoyan . Is that correct . You agree that increasing the utilization of existing, tested data sources is one easy way that cms can reach the mutual goal of expanding Program Integrity and management and better access to fraud risk . Yes, thats, in fact, one of our recommendations to cms is to consider doing that on an active basis, both to capture the data and then analyze the data for whatever indicators that they may throw off and act upon those, yes. Then do you have any idea when cms is going to move forward to actually take advantage of that and do it . Well, as i stated before in response to several senators questions, cms has accepted those recommendations. They are on record in writing as having done so. And as i said in my opening statement, it is now incumbent on the agency to take action on a timely basis. But as i said, it will take time to work through this. Its not an easy fix, its not a shortterm fix, its not a oneanddone fix. Well, i apologize for being late, because obviously, you covered it in your opening statement, but there is readily available data and companies that are available to provide information that are already under contract to cms that could greatly enhance the integrity of the program and uproot fraud a lot easier, and i appreciate your testimony to that effect. Yeah, the data are available, definitely. Thank you. Thank you, mr. Chairman