Bill Summary
The "Fraud Risk Assessment of Obamacare Subsidies Accountability Act" is a piece of legislation aimed at enhancing the oversight and accountability of the advance premium tax credits provided under the Affordable Care Act (ACA). It requires the Secretary of Health and Human Services, in coordination with the Secretary of the Treasury, to conduct a comprehensive fraud risk assessment of these tax credits. This assessment must be completed by December 31, 2025, and annually thereafter.
The assessment will involve evaluating the risk of fraud associated with the advance determinations of premium tax credits, which help eligible individuals afford health insurance. Additionally, the Secretary is mandated to create a detailed report that includes a list of controls implemented to prevent fraud in the claims process.
The findings of the assessment must be submitted to various congressional committees and the Inspector General of the Department of Health and Human Services, ensuring that lawmakers are informed about potential vulnerabilities and the effectiveness of fraud prevention measures. The assessments are to be conducted in line with established principles aimed at managing fraud risks in federal programs.
Possible Impacts
Here are three examples of how the "Fraud Risk Assessment of Obamacare Subsidies Accountability Act" could affect people:
1. **Increased Scrutiny of Premium Tax Credits**: With the implementation of annual fraud risk assessments, individuals and families applying for advance premium tax credits may face more stringent eligibility checks. This could lead to delays in receiving subsidies or increased documentation requirements, potentially making it more difficult for some applicants to access affordable health insurance.
2. **Enhanced Fraud Prevention Measures**: The requirement for the Secretary of Health and Human Services to develop and implement controls to prevent fraud may lead to improved security measures and verification processes. While this could help protect taxpayer money and ensure that subsidies are only given to eligible individuals, it might also result in legitimate applicants encountering obstacles or additional scrutiny in the application process, which could create frustration or confusion.
3. **Increased Accountability and Transparency**: The act mandates that fraud risk assessments be submitted to various congressional committees and oversight bodies. This increased accountability could lead to greater transparency in how advance premium tax credits are managed and allocated. For the public, this could foster trust in the system, as stakeholders can better understand how funds are being used and how fraud is being addressed, although it may also lead to political debates and discussions about health care funding and eligibility criteria.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 3384 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 3384
To require the Secretary of Health and Human Services to complete fraud
risk assessments of the advance premium tax credit, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 8 (legislative day, December 4), 2025
Mr. Grassley introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To require the Secretary of Health and Human Services to complete fraud
risk assessments of the advance premium tax credit, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Fraud Risk Assessment of Obamacare
Subsidies Accountability Act''.
SEC. 2. FRAUD RISK ASSESSMENT.
(a) In General.--Not later than December 31, 2025, and annually
thereafter, the Secretary of Health and Human Services, in coordination
with the Secretary of the Treasury, shall prepare a fraud risk
assessment of the advance determinations under section 1412 of the
Patient Protection and Affordable Care Act (42 U.S.C. 18082) of premium
tax credits allowable under section 36B of the Internal Revenue Code of
1986, including a complete list of any controls used by the Secretary
of Health and Human Services for purposes of preventing fraud with
respect to advance premium tax credit claims, and submit such
assessment to--
(1) the Inspector General of the Department of Health and
Human Services;
(2) the Committee on Finance, the Committee on the Budget,
and the Committee on Health, Education, Labor, and Pensions of
the Senate; and
(3) the Committee on Ways and Means, the Committee on the
Budget, and the Committee on Energy and Commerce of the House
of Representatives.
(b) Requirements.--Each fraud risk assessment under subsection (a)
shall be conducted in accordance with the principles of the report of
the Comptroller General of the United States titled ``A Framework for
Managing Fraud Risks in Federal Programs'', issued in July 2015.
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