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Audit

Audit  Audit of the Commonwealth Health Insurance Connector Authority

Our office conducted a performance audit of the Commonwealth Health Connector Insurance Authority (Connector) for the period July 1, 2021 through June 30, 2023.

Organization: Office of the State Auditor
Date published: December 23, 2024

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 the Commonwealth Health Connector Insurance Authority (Connector) for the period July 1, 2021 through June 30, 2023.

The purpose of our audit was to determine whether the Connector did the following:

  • conducted eligibility requirement tests to ensure that all applicants who received benefits met the criteria established by Sections 12.05 and 12.06 of Title 956 of the Code of Massachusetts Regulations;
  • had policies and procedures in place to process complaints and documented actions taken to resolve complaints received; and
  • provided annual cybersecurity awareness training to its employees in accordance with Sections 6.2.3 and 6.2.4 of the Executive Office of Technology Services and Security’s Information Security Risk Management Standard IS.010

Below is a summary of our finding, the effect of that finding, and our recommendations, with links to each page listed.

  
Finding 1
 		The Connector does not maintain a log of possible fraud complaints received.
EffectWithout documentation of fraud complaints received, the Connector cannot monitor the number of complaints, as well as actions taken to address specific complaints.
Recommendations
 
  1. The Connector should develop and implement written policies and procedures surrounding the receipt and resolution of complaints.
  2. All fraud complaints received should be logged into the Connector’s privacy and security incidents log, along with documentation to support the actions taken to resolve them.

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