This image is excerpted from a U.S. GAO report:
PATIENT PROTECTION AND AFFORDABLE CARE ACT: CMS Should Act to Strengthen Enrollment Controls and Manage Fraud Risk
Notes: A single application may represent more than one person, and different people on an application may have different number or types of inconsistencies. Because subsidy information is at the application level, subsidy amounts are not mutually exclusive by category.
a) Other inconsistency types are American Indian status, and presence of qualifying employer-sponsored coverage or other minimum essential coverage.
b) Resolved status indicates inconsistencies resolved by consumer action, such as document submission, or removed due to events such as life change, application deletion, or consumer cancellation.
c) Open status indicates applications with inconsistencies that had no reported resolution as of April 2015. Figures by category of inconsistency do not sum to total because the categories are not mutually exclusive.
d) Terminated/adjusted status indicates the federal Health Insurance Marketplace has terminated policies or adjusted subsidies based on failure to submit documentation to resolve inconsistencies.
Posted by U.S. GAO on 2016-03-17 13:47:09
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