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Audit Audit of the Commonwealth Health Insurance Connector Authority

This audit of the Commonwealth Health Insurance Connector Authority evaluated the program's ability to verify the eligibility of individuals to receive benefits and properly provide customer services. The audit examines the period of July 1, 2014 through June 30, 2016.

Binder organization: Office of the State Auditor
Date published: January 16, 2018

Executive Summary

In accordance with Section 12 of Chapter 11 of the Massachusetts General Laws, the Office of the State Auditor has conducted a performance audit of certain activities of the Commonwealth Health Insurance Connector Authority (CCA) for the period July 1, 2014 through June 30, 2016. In this performance audit, we determined whether CCA was properly verifying the eligibility of applicants and individuals/families currently receiving benefits and whether CCA was providing a sufficient level of customer service.

Below is a summary of our findings and recommendations, with links to each page listed.

Finding 1

CCA did not ensure that its database was accurate.

Recommendations

  1. CCA should review its verification process and ensure that adequate controls (policies and procedures) exist that require information in its database to be reviewed for completeness and accuracy and updated appropriately on a regular basis to keep its database accurate and to better ensure that only eligible participants receive benefits.
  2. CCA should immediately take the measures necessary to update the information in its database.

Finding 2

CCA did not ensure that adequate customer service was provided.

Recommendations

  1. CCA should implement internal controls to allow it to monitor performance metrics to determine Dell Marketing LP’s compliance with the service-level agreements.
  2. CCA should provide adequate cross-training of key personnel who are responsible for reviewing invoices for accuracy.

The PDF version of the Commonwealth Health Insurance Connector Authority is available here.

List of Abbreviations

APTC

Advance Premium Tax Credit

CCA

Commonwealth Health Insurance Connector Authority

CMR

Code of Massachusetts Regulations

CSR

cost-sharing reduction

RFI

request for information

SLA

service-level agreement

Contact

Phone

Fax

(617) 727-3014

Address

Massachusetts State House
Room 230
Boston, MA 02133

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