RECOVERY
ACT
Health Coverage Tax Credit Recovery Act Provisions Were Timely Implemented, but Program Capacity Is Limited
September 24, 2010
Reference Number: 2010-41-122
This report has cleared the Treasury Inspector General for Tax Administration disclosure review process and information determined to be restricted from public release has been redacted from this document.
Phone
Number | 202-622-6500
Email Address | inquiries@tigta.treas.gov
Web Site |
http://www.tigta.gov
HIGHLIGHTS
HEALTH COVERAGE TAX CREDIT RECOVERY
ACT PROVISIONS WERE TIMELY IMPLEMENTED, BUT PROGRAM CAPACITY IS LIMITED
Highlights
Final
Report issued on September 24, 2010
Highlights of
Reference Number: 2010-41-122 to the
Internal Revenue Service Commissioner for
the Wage and Investment Division.
IMPACT ON TAXPAYERS
The Health Coverage Tax Credit
(HCTC) is a refundable tax credit and was created to assist certain workers who
lost their jobs due to foreign trade and retirees who receive payments from the
Pension Benefit Guaranty Corporation.
Our review identified that processes were developed to ensure HCTC
payments were timely and accurately processed.
All payments TIGTA reviewed were sent to the Health Plan Administrators
on time to ensure the continuity of the individual’s health coverage.
WHY TIGTA DID THE AUDIT
The American Recovery and
Reinvestment Act of 2009 (Recovery Act) included provisions to help make health coverage more
affordable. These provisions are
expected to improve the availability of health coverage to eligible individuals
and their qualifying family members. In
Calendar Year 2008, the Internal Revenue Service (IRS) processed 159,012
payments totaling $121.8 million, which included $44.1 million in payments
from individuals and $77.7 million in Federal Government subsidies. Our overall objective was to evaluate the efficiency
and effectiveness of HCTC payment processing.
WHAT TIGTA FOUND
The IRS timely and accurately
implemented provisions relating to the Advance Monthly Payment
Option included in the Recovery Act. Our
review identified that the IRS increased the Federal Government portion of
health insurance premiums paid from 65 percent to 80 percent. The IRS also implemented processes to enable
individuals to request reimbursement for premiums paid while enrolling in the
Advance Monthly Payment Option.
Although TIGTA found that payments were timely and accurately
processed, the IRS will face challenges if there is a significant increase in
the number of monthly enrolled participants.
Current IRS systems are built to support only 57,000 enrolled
participants in any given month. In
addition, TIGTA identified that eligibility indicators for 3,661 individuals in
Calendar Year 2009 could not be posted to the respective individuals’ IRS tax
account. HCTC Program management noted
that a business decision was made to not resolve these unpostable conditions because
they represent less than 1 percent of the accounts for which an indicator is
added. Not establishing a process to
resolve unpostable situations can have a negative impact on these individuals
and result in taxpayer burden.
WHAT TIGTA RECOMMENDED
TIGTA recommended that the Commissioner, Wage and
Investment Division, develop a process to ensure accuracy of Health Plan
Administrators’ information on the IRS financial system and HCTC financial
system; ensure individuals participating in the Advance Monthly Payment Option
receive accurate Health Coverage Tax Credit (HCTC) Advance Payments (Form
1099-H) payment information; and identify and resolve unpostable records to
ensure eligibility indicators are added to individuals’ tax accounts.
The IRS agreed with two of the three
recommendations. The IRS disagreed with
our recommendation to ensure individuals receive accurate Forms 1099-H. IRS management indicated that individuals
receive accurate Forms 1099-H and the form is for information only. Notwithstanding IRS management’s response, TIGTA
found that some individuals did receive inaccurate Forms 1099-H. Form 1099-H needs to be accurate because
individuals receiving Forms 1099-H use this information when preparing their
tax returns.
September 24, 2010
MEMORANDUM FOR COMMISSIONER, WAGE AND INVESTMENT DIVISION
FROM: (for) Michael R. Phillips /s/ Margaret E. Begg
Deputy Inspector General for Audit
SUBJECT: Final Audit Report – Health Coverage Tax Credit Recovery Act Provisions Were Timely Implemented, but Program Capacity Is Limited (Audit # 201040106)
This report presents the results of our review to evaluate the efficiency and effectiveness of the Health Coverage Tax Credit payment processing. This audit was conducted as part of the Treasury Inspector General for Tax Administration Fiscal Year 2010 Annual Audit Plan and addresses the major management challenges of Taxpayer Protection and Rights and Erroneous and Improper Payments and Credits.
The American Recovery
and Reinvestment Act of 2009 (Recovery Act)[1] provides separate funding to the Treasury
Inspector General for Tax Administration through September 30, 2013, to be used
in oversight activities of Internal Revenue Service programs. This audit was conducted using Recovery Act
funds.
Management’s
complete response to the draft report is included in Appendix VII.
Copies of this
report are also being sent to the Internal Revenue Service managers affected by
the report recommendations. Please
contact me at (202) 622-6510 if you have questions or Michael E. McKenney,
Assistant Inspector General for Audit (Returns Processing and Account Services),
at (202) 622-5916.
Advance Monthly
Payments Were Timely and Accurately Processed
Improvements
Can Be Made to Increase the Efficiency of the Advance Monthly Payment
Processing
Appendices
Appendix
I – Detailed Objective, Scope, and Methodology
Appendix
II – Major Contributors to This Report
Appendix
III – Report Distribution List
Appendix
IV – Health Coverage Tax Credit (Form 8885)
Appendix
V – Role of Each Location in the Health Coverage Tax Credit Program
Appendix
VI – The Health Coverage Tax Credit (HCTC) Reimbursement Request (Form 14095)
Appendix
VII - Management’s Response to the Draft Report
Abbreviations
|
HCTC |
Health Coverage Tax Credit |
|
IRS |
Internal Revenue Service |
|
PBGC |
Pension Benefit Guaranty Corporation |
|
TIN |
Taxpayer Identification Number |
The intent of the HCTC is to make health coverage more affordable for certain groups of people who otherwise might not be insured.
The Health Coverage Tax Credit (HCTC) was signed into law on August 6, 2002, as a component of the Trade Adjustment Assistance Reform Act of 2002.[2] The HCTC is a refundable tax credit[3] and was created to assist certain workers who lost their jobs due to foreign trade and who receive benefits through the Trade Adjustment Assistance or Alternative Trade Adjustment Assistance programs as well as eligible recipients of pensions that are being paid by the Pension Benefit Guaranty Corporation (PBGC).[4]
The Internal Revenue Service (IRS) administers the HCTC in partnership with other Federal agencies, States, and the private health care industry. State workforce agencies, the Department of Labor, and the PBGC are responsible for identifying potentially eligible individuals. The State workforce agencies and the PBGC transmit records of potentially eligible individuals to the IRS. States transmit this information daily and the PBGC transmits monthly. The IRS created the HCTC Program office to oversee the administration of the HCTC. The IRS is responsible for ensuring that potentially eligible individuals meet program requirements and that monthly payments are accurately processed. This includes:
· Sending monthly invoices to eligible individuals for their share of the monthly medical premium.
· Processing monthly payments from individuals.
· Combining the individual’s payment with the Federal Government’s share of the monthly medical premium and forwarding the full monthly premium payment to the Health Plan Administrator.
· Providing annual information detailing the amounts paid by the individual and Federal Government for monthly health insurance premiums for posting to individuals’ tax accounts.
The HCTC can be obtained in the following ways:
· Annually - Individuals can claim the credit on their annual Federal tax return by preparing and including a Health Coverage Tax Credit (Form 8885).
·
Advance
Monthly - This option allows more affordable and accessible health
coverage for eligible individuals because a significant percentage of their
monthly health insurance premium is subsidized by the Federal Government. Individuals can submit an application to the
IRS requesting enrollment in the Advance Monthly Payment Option. The IRS ensures the individual meets program
requirements.
·
Combination
- Some individuals claim the credit using a combination of claiming the credit
on their annually filed tax return and also receiving the advance monthly
credit.
Figure 1 shows the number of individuals participating in the Advance
Monthly Payment Option during Calendar Years 2007 through 2009.
Figure 1: Number of HCTC
Participants Participating in the Advance Monthly Payment Option for Calendar
Years 2007 through 2009
|
Advance Monthly
Payment Option
|
|||
|
Number of Monthly Participants
|
Number of Monthly
Payments[5] |
Amount of Monthly
Payments[6] |
|
|
2007 |
21,877 |
171,227 |
$127 M |
|
2008 |
20,489 |
159,012 |
$122 M |
|
2009 |
26,960 |
192,373 |
$148 M |
Source: IRS’
HCTC Program office.
Contractors and other Federal agencies assist in the Advance Monthly
Payment processing
The Health Insurance Tax Credit Administration appropriation
provides funding for contractor support to administer the HCTC Advance Monthly
Payment Option. The HCTC Payment Processing Operation uses several facilities nationwide
for the processing of Advance Monthly Payments.
Appendix V provides a description of these facilities.
Figure 2 details the payment processing for the Advance Monthly Payment
Option.
Figure 2: Payment Process for Advance Monthly Payment
Option
Figure 2 was removed due to its
size. To see Figure 2, please go to the
Adobe PDF version of the report on the TIGTA Public Web Page.
The American Recovery and Reinvestment Act of 2009 (Recovery Act)[7] activities require a high level of scrutiny, and taxpayer dollars spent on economic recovery must be subject to unprecedented levels of transparency and accountability. Federal agencies are required to ensure Recovery Act funds are used for authorized purposes and appropriate measures are taken to prevent fraud, waste, and abuse. As such, the Treasury Inspector General for Tax Administration is required to monitor IRS implementation of Recovery Act provisions, and this audit was conducted to meet those requirements.
This review was performed at the HCTC Program office in
Advance Monthly Payments Were Timely and Accurately Processed
Processes have been developed to ensure accurate and timely
processing of HCTC Advance Monthly Payments.
The IRS is responsible for processing and approving all payments on
behalf of HCTC participants. The IRS has
developed processes and has taken actions in an effort to ensure the accurate
and timely processing of payments for those individuals participating in the
Advance Monthly Payment Option. In
Calendar Year 2008, the IRS processed 159,012 payments totaling $121.8 million,
which included $44.1 million in payments from individuals and $77.7 million in
Federal Government subsidies.
Our review of a statistically valid sample of Advance Monthly Payments
associated with 90 individuals in Calendar Year 2008 found that payments were
timely and accurately processed. There
were a total of 731 payments processed for these individuals. We traced these payments from the receipt of
the participating individual monthly premium payment through to the issuance of
the payment to the Health Plan Administrator.
We found that all payments were sent to the Health Plan Administrators
on time to ensure the continuity of the individual’s health coverage.
The accuracy of payment processing is primarily attributable to the
multiple monthly accounting reconciliations the IRS performs. These reconciliations are used to ensure the
accuracy of Advance Monthly Payment processing from receipt of an individual’s
payment at the bank to the posting of the payment that is transmitted to the
Health Plan Administrator to an individual’s tax account. These reconciliations are designed to
identify discrepancies between the multiple systems used by the various Government
agencies and the contractor involved in the processing of the Advance Monthly
Payments. If discrepancies are
identified, efforts are initiated to resolve the discrepancy. Figure 3 provides a brief description of the reconciliations performed by the IRS.
Figure 3:
Reconciliations of Advance Monthly Payment Option
|
Category |
Description |
|
Designated
Site for Processing Individuals’ Payments |
● Verifies that the site’s deposit of
individuals’ payments agrees with the Government’s deposit and HCTC payment
records. |
|
|
|
|
Credit
Card |
● Confirms the
deposit of individuals’ payments by credit card agrees with the records of
the credit card processing center. |
|
|
|
|
Health
Plan Administrators |
● Verifies that the amount received
from an individual is paid to the Health Plan Administrator. ● Identifies differences between the
individuals’ payments and payments sent to Health Plan Administrators. ● Verifies the amount paid to the HCTC
Program’s Health Plan Administrators agrees with the Government’s Health Plan
Administrators payments. ● Compares the total General Ledger
expense amount with the total Health Plan Administrators payment runs. |
|
|
|
|
Returned
Funds/Repayments |
● Verifies returned
funds/repayments ending balance agrees with accounting records. ● Low credit balance on an
individual’s account or small |
|
|
|
|
Refunds |
● Reconciles the Refund Voucher
amounts forwarded to the IRS with the ● Researches individuals’ accounts
with credits to determine whether appropriate to issue a refund. |
|
|
|
|
Accounts Receivable
and Accounts Payable |
● Identifies any receivable accounts
that do not have a zero balance and verifies all payable accounts have been
paid. |
Source: IRS’ HCTC Program.
Our review of reconciliations performed during the period January 2008
to September 2009 showed that each month the IRS performed the reconciliations
designed to ensure payments were accurately processed. In addition, our validation of the December
2008 reconciliations identified that the discrepancies identified from these
reconciliations were timely resolved by the IRS.
Actions Were Taken to Implement the Health Care Tax Credit Provisions Included in the American Recovery and Reinvestment Act of 2009
The IRS timely and
accurately implemented provisions relating to the Advance Monthly Payment
Option included in the Recovery Act. The
Recovery Act included provisions to help make health coverage more affordable. These provisions are expected to improve the
availability of health coverage to eligible individuals and their qualifying
family members. Provisions include:
·
Changing
the Federal Government portion of health insurance costs. The Federal Government subsidy of the health
care premiums increased from 65 percent to 80 percent for qualified health insurance
premiums. The increase covers the period April 2009 through December 2010.
·
Allowing
individuals to receive reimbursement for premiums paid while enrolling in the Advance
Monthly Payment Option (beginning August 2009 through December 2010) rather than waiting to file
their annual tax return to claim the HCTC.
·
Allowing
family members to continue receiving the HCTC after certain life events.
·
Expanding
taxpayer eligibility in the Program.
Our review confirmed that the IRS increased the Federal Government
portion of health insurance premiums paid from 65 percent to 80 percent. The IRS developed the necessary programming
to increase the Federal Government portion for individuals participating as of
April 2009. The increased portion was
reflected in participants’ April 2009 invoices that were sent prior to the
April 17, 2009, due date specified in the legislation.
In addition, the number of individuals
participating in the Advance Monthly Payment Option during the period April
2009 to April 2010 increased 67 percent.
Figure 4 shows that, since the Recovery Act raised the percentage of
health insurance premiums paid by the Government, the number of individuals participating
in the Advance Monthly Payment Option increased from 15,553 individuals in April
2009 to 25,960 in April 2010.
Figure 4: Participation in the Advance Monthly Payment Option Since
the Recovery Act Increased the Percentage of Health Insurance Premiums Paid by
the Government
Figure 4 was
removed due to its size. To see Figure 4,
please go to the Adobe PDF version of the report on the TIGTA Public Web
Page.
Furthermore, the IRS implemented processes to enable individuals to
request reimbursement for premiums paid while enrolling in the Advance Monthly
Payment Option. To implement the requirements of
the Recovery Act, the IRS:
·
Developed
The Health Coverage Tax Credit (HCTC) Reimbursement Request (Form 14095)[9] and associated instructions. Individuals use this form to request
reimbursement for 80 percent of the premiums that they paid
directly to a qualified health plan while enrolling in the monthly HCTC
Program. For example:
Example: Individual
A pays monthly health premiums of $450 directly to his or her health plan for
the months September, October, and November 2009. Individual A is eligible to receive the HCTC
and elects to participate in the Advance Monthly Payment Option, completing the
Monthly HCTC Registration Form to enroll in this option. When registering for the Advance Monthly
Payment Option, Individual A can now request reimbursement for 80 percent of
the $450 the individual paid for his or her health insurance premiums for the
months of September through November 2009.
Once the HCTC Program processes the registration form, reimbursement
request, and supporting documentation for each month, Individual A will receive
a reimbursement credit totaling $360 (80 percent of the $450 they paid) for
each month on his or her HCTC account.
·
Added a
Reimbursement Request section to the HCTC Program Kit[10]
for an individual to request
reimbursement of premiums he or she paid when registering for the Advance
Monthly Payment Option.
·
Updated
the IRS web site (IRS.gov) to include information regarding the reimbursement
option resulting from provisions in the Recovery Act.
·
Established
a work site staffed by 11 Invoice Verification Customer Service Representatives
and 6 accountants located in
To claim a reimbursement, an individual must prepare
either the stand alone Form 14095 or The Health Coverage Tax Credit (HCTC) Reimbursement
Request Form (Form 14095-A) in the Health
Care Tax Credit Program Kit (Publication 4181) and mail the form to the
IRS’ San Antonio site for processing. Either
form requires the individual to identify the eligible month(s), monthly payment
amounts, dates of payment, and total premiums paid for which reimbursement is
being requested.
Individuals must attach proof of payment with
the submitted request form. If approved,
the HCTC Program posts the reimbursement as a credit on the individual’s HCTC
account. If denied, a letter is mailed
to the individual to explain why his or her request for reimbursement was not
approved. An individual’s reimbursement
claim can be denied for various reasons, such as ineligibility, the reimbursement
request is from a previous tax year, or the individual is not currently
registered for the Advance Monthly Payment Option.
Our review showed that the IRS
received 7,798 reimbursement claims submitted by individuals from September
2009 through January 2010. As of January
27, 2010, the IRS processed and approved 6,824 reimbursements totaling more
than $4.8 million. Our review of a
statistically valid sample of 135 reimbursement credits for 74 individuals
identified that reimbursement credits were timely (on average claims were
processed within 50 calendar days) and accurately processed with amounts
requested for reimbursement supported by proof of payment.
The IRS processed and approved 6,824 HCTC reimbursement claims as
of January 27, 2010, totaling more than $4.8 million.
However, our review found
the reconciliation that HCTC Program management currently performs for reimbursement
credits is a time-consuming manual process and increases the risk of potential
errors. The reconciliation assists the
IRS in ensuring the accuracy of the amounts provided for reimbursement. The reconciliation requires the HCTC Program manager
to compare each line of the Reimbursement General Ledger Report to the Posted
Report showing the reimbursement credits that have posted to individuals’
accounts. In December 2009, the
Reimbursement General Ledger report had 3,083 line items that had to be
manually compared to the report of posted reimbursement credits to confirm the
accuracy of the information.
HCTC management indicated that it is very time consuming to manually compare approximately 1,702 reimbursement credits on the individuals’ accounts to the accounting records. HCTC management is aware of the benefits of automating reconciliation processes. Representatives from the HCTC Project Office indicated that they elected to perform the reconciliation manually to monitor the processing of reimbursement claims to identify any problems with processing and to identify opportunities to automate steps in the process. Subsequent to our discussion with IRS management, the process of reconciling reimbursement credits was automated in February 2010. Management noted that additional report enhancements are planned.
Improvements Can Be Made to Increase the Efficiency of the Advance Monthly Payment Processing
Although we found that payments were timely and accurately
processed, the IRS will face challenges if there is a significant increase in
the number of monthly enrolled participants as a result of provisions included in the Recovery Act or the newly
enacted health reform legislation. Prior
to the Recovery Act, the IRS estimated the number of potentially eligible
individuals to be approximately 300,000 in any given month. Estimates in support of the provisions in the
Recovery Act indicate 570,000 individuals could be eligible. Notwithstanding the estimates of potential
participants, IRS management noted that the HCTC Program and systems[11] are built to support only 57,000 enrolled participants.
The number of
enrolled individuals participating in the Advance Monthly Payment Option
increased by 67 percent from April 2009 (implementation of the Recovery Act) to
April 2010. Participation is low when
compared with the large number of individuals that are eligible to
participate. However, results of surveys
required by the Recovery Act may further increase participation. To address concerns regarding low participation,
the Recovery Act requires the Secretary of the Treasury to perform a biennial survey
of individuals eligible to participate in the HCTC Program. The survey and report would include both HCTC
participants and non-HCTC participants and may help identify potential causes
for the low participation. Results of
these surveys may be used to help increase participation.
Further, the Patient Protection and Affordable Care Act[12] and the Health Care and Education Reconciliation Act of 2010[13] created another refundable tax credit (Premium Assistance Credit) for eligible individuals and families who purchase health insurance through an exchange. Like the HCTC, the Premium Assistance Credit allows for the advance payment of the premium assistance tax credits. The Federal Government would pay the Premium Assistance Credit amount directly to the individual’s insurance plan. Current projections indicate potentially 29 million individuals would receive these Federal premium subsidies, estimated to cost $511 billion through Fiscal Year 2019. If it is necessary for the HCTC Program office to be involved in the administration of the Premium Assistance Credit, it would present additional Program administration challenges.
To process Advance Monthly Payments, the IRS was required to create
the HCTC financial system, which is separate from IRS’ systems for tax
accounts.
The current Advance Monthly Payment process requires significant coordination between multiple Federal agencies, contractors, and the IRS. Payments are received at the lockbox site and processed and deposited. Once this is completed, a payment file is transmitted to the HCTC financial system. This starts a complex process to add the Federal Government portion of the premium to the individual’s portion and then eventually the payment is sent to the Health Plan Administrator. Because the HCTC financial system is separate from the IRS’ systems for tax accounts, each year transactions have to be posted to the individual’s tax account reflecting monthly individual and Federal Government HCTC payments.
Although a number of electronic systems are involved in the processing of payments, significant manual involvement is needed to ensure payments are accurately processed. Reconciliations identify discrepancies regarding payments and have to be manually researched and resolved. For instance, each month the Open Items on Closed Contract Reconciliation identifies all individuals with a credit balance on their account. These accounts must be manually reviewed to determine whether the outstanding credits on individual accounts should be refunded. In September 2009, this reconciliation identified 148 individuals with credit balances. It took 2 accountants 3 to 4 days to review these accounts and to take the appropriate actions. The IRS issues a refund to an individual when the credit on his or her account is a result of contract cancellation. However, individuals can have credits on their HCTC account for a variety of reasons. Often, an individual makes an overpayment in the current month to cover premiums in future months, and the credit from the overpayment stays on the individual’s account until the IRS draws it down to pay for the next month’s participant portion of the premium.
Overall, the IRS has effectively administered the HCTC but its capacity is very limited (maximum capacity is 57,000 enrolled participants). In 2007, the IRS performed a study to identify Program administration and system needs if participation increases above 57,000. This study included an analysis of administrative costs and actions that would need to be taken should the number of enrolled participants increase above the maximum level of 57,000 individuals. The study noted the significant interaction that the Program requires with both the participant and the Health Plan Administrator. The study found that the monthly HCTC Program interacts with an average participant 30 to 35 times per year as well as at least 12 interactions with a Health Plan Administrator.
Processes are
needed to ensure the accuracy and consistency of information included in
the various payment processing systems
The Advance Monthly Payment Option requires coordination between multiple entities and several computer systems. As a result, the payment processing systems are vulnerable to inconsistencies because of the continual need for exchanging payment data between the HCTC and IRS systems.
Identification
of Health Plan Administrators participating in the Advanced Monthly Payment
Program is inconsistent between the HCTC and IRS systems. Our comparison of Health Plan
Administrators contained on the IRS’ financial system[14]
showed 183 more Health Plan Administrators than listed on the HCTC financial system. HCTC Program management indicated that the
list we received on November 6, 2009, was the HCTC master list of Health Plan
Administrators that have or currently are participating in the Advance Monthly
Payment Option. These 183 Health Plan
Administrators were created on the IRS’ financial system during the period
September 9, 2004, to November 6, 2009. In addition, we identified another 20 Health
Plan Administrators for which the Taxpayer Identification Number (TIN)[15] listed for the Health Plan Administrator was
not consistent between the IRS financial system and the HCTC financial
system. Eight of these 20 Health Plan
Administrators received 419 payments for individuals’ medical premiums
totaling $229,127.68 in Calendar Year 2008.
The IRS financial system routinely
interfaces with the external HCTC financial system[16]
at the
Inconsistencies
were identified between payment transactions reflected on the HCTC financial
system and payment transactions on the participating individuals’ tax accounts. Our review of Calendar Year 2008
transactions identified 174 individuals that received a Health Coverage Tax
Credit (HCTC) Advance Payments (Form 1099-H)[17]
with an amount that did not agree with their HCTC amounts on their tax account. Inaccurate information on Forms 1099-H can
result in individuals erroneously claiming an incorrect HCTC amount when filing
a tax return. For these 174 individuals,
the total amount reflected on their Form 1099-H did not match the amount of
Federal Government payments reflected on their IRS tax accounts. These discrepancies totaled $60,534. The IRS has not developed a process to ensure
that the Federal Government payments reported on IRS tax accounts are
consistent with those reported to taxpayers on Forms 1099-H.
IRS tax account information for individuals participating in the Advance Monthly Payment Option should accurately reflect the total payments paid by the individual and the total subsidized payments paid by the Federal Government during the year. The IRS issues a Form 1099-H to each individual participating in the Advance Monthly Payment Option to show him or her the amount of the Federal Government subsidy that was paid each month of a year for his or her medical premiums. An individual can use this information to determine the amount he or she can claim at year-end on his or her annual tax return.
HCTC records contained some
invalid TINs for Health Plan Administrators.
Our comparison of
Health Plan Administrator TINs included in the HCTC systems to IRS tax records
identified 34 (1 percent) of 2,671 Health Plan Administrators on the HCTC’s November
6, 2009, list as having an invalid TINs.
An invalid TIN is one that has not been assigned by the IRS to the
Health Plan Administrator. When we
brought this issue to the attention of HCTC Program management, they responded
that the accuracy of a Health Plan Administrator’s TIN is not imperative as
this information is not relevant for the HCTC systems.
Notwithstanding
management’s position, we believe that the IRS should ensure that the Health
Plan Administrator TINs are accurately reflected in HCTC systems. Based on our review of the registration forms
submitted to the HCTC Program by these 34 Health Plan Administrators, 16 (47
percent) of the invalid TINs were the result of an HCTC employee not correctly
inputting the information into the HCTC systems.
Processes should be established to ensure HCTC eligibility indicators are added to the associated individuals’ tax accounts
Our review identified that eligibility indicators for 3,661 individuals in Calendar Year 2009 could not be posted to the respective individuals’ IRS tax account. HCTC Program management has indicated that they are aware that indicators are unable to post to some of the eligible individuals’ tax accounts. Management noted that a business decision was made to not resolve these unpostable conditions because they represent less than 1 percent of the accounts for which an indicator is added.
However, in our review of a statistically valid sample of 111 of the 3,661 unpostable accounts, we were able to locate the associated IRS tax account for 55 (50 percent) of the individuals for which the indicator was unpostable. For the remaining 56, there was no record of a tax account for the individual for Calendar Year 2009; therefore, the IRS would have been unable to post the indicator. The IRS should identify unpostable eligibility indicators and, once identified, research those individuals for whom a tax account exists to add the indicator.
Every
December, the IRS generates a tape from the HCTC customer management system[18] that identifies individuals eligible for the
HCTC. This tape is used to update the
IRS tax account information that allows the individual to claim the HCTC on his
or her annual tax return. Without this
indicator, the individual cannot receive money for the premium paid throughout
the year. For example:
Example: Individual
A makes monthly premium payments directly to his or her health provider throughout
the year and claims the HCTC on his or her annual tax return and attaches Form
8885 with the required supporting documentation. Because the HCTC indictor is not present on
the individual’s IRS tax account, the HCTC is disallowed and the tax return is
sent to the Error Resolution function and tax examiners will correspond with
the taxpayer. The individual would be
required to contact his or her State agency or the PBGC to obtain evidence that
he or she is eligible for the HCTC. Once
the individual receives the evidence of eligibility, that evidence would have
to be forwarded to the HCTC Program and ultimately worked by a post-processing
function, IRS Accounts Management. This
process will needlessly delay the individual from receiving the HCTC to which he
or she is entitled.
Not
establishing a process to resolve unpostable situations can have a negative impact
on these individuals and result in taxpayer burden. If an individual legitimately elects to claim
both the monthly credit and the year-end credit, they could not receive the
year-end credit because there is no eligibility indicator on the IRS tax
account because the unpostable condition was not resolved. In addition, an individual would receive a
Form 1099-H generated from the HCTC customer management system; however, the
advance payment information on the Form 1099-H would not be reflected on the
IRS tax account because the eligibility and advance payments did not post for
that individual.
Recommendations
The Commissioner, Wage and Investment Division, should:
Recommendation 1: Develop a process to ensure Health Plan Administrators reflected on the HCTC systems are consistent with those reflected on the IRS systems. This should include ensuring Health Plan Administrators are consistently listed on the IRS financial system and the HCTC financial system and Health Plan Administrators’ TINs are valid.
Management’s
Response:
The
IRS agreed with this recommendation. A
joint effort was launched August 2, 2010, by the
Also, the HCTC Payments Processing
Team and the
Recommendation 2:
Develop a process to ensure individuals
participating in the Advance Monthly Payment Option receive accurate Form
1099-H payment information.
Management’s Response: The IRS disagreed with this recommendation because individuals participating in the Advance Monthly Payment Option do receive accurate Form 1099-H payment information. Data contained on Form 1099-H are for information only. If payment information is updated or changed, a corrected Form 1099-H is issued to the taxpayer and to the IRS. All IRS HCTC systems correctly reflect accurate payment data.
Office of Audit Comment: Notwithstanding IRS management’s response, some individuals did receive inaccurate Form 1099-H information. As we detailed in our report, 174 individuals received a Form 1099-H with an amount that did not agree with the HCTC amounts on their tax account. In addition, the IRS indicates that the Form 1099-H is for information only. We agree that the Form 1099-H provides information to individuals on the amount of HCTC Federal Government payments, which is the reason that it should be accurate. Individuals receiving Forms 1099-H use this information when preparing their tax returns.
Recommendation 3: Develop a process to identify and resolve unpostable records to ensure eligibility indicators are added to individuals’ tax accounts.
Management’s
Response: The
IRS agreed with this recommendation; however, additional corrective action is
not necessary. The IRS submitted a
Unified Work Request that was approved by the Modernization and Information
Technology Services organization for Tax Year 2011 to identify unpostable
transactions and generate a report. This
report will be used to manually post these transactions to the Master File.
Appendix I
Detailed Objective, Scope, and Methodology
Our overall objective was to evaluate the efficiency and effectiveness of HCTC payment processing. To accomplish our objective, we:
I. Determined whether reconciliations are performed to ensure accuracy of monthly HCTC financial records.
A. Determined whether reconciliations for Calendar Year 2008 and Calendar Year 2009, through September, were performed timely.
B. Assessed whether the reconciliations for Calendar Year 2008 and Calendar Year 2009, through September, identified discrepancies and, if so, whether corrective actions were taken to address the discrepancies.
C. Obtained the reconciliations completed in December 2008 to determine whether discrepancies identified were resolved timely and completed correctly.
D. Determined the methodology that the HCTC Program uses to ensure reconciliations are effectively conducted.
II. Determined whether payments are accurately calculated and timely processed.
A. Determined whether parameters have been established to limit payment of an individual’s health insurance premium to a designated price level.
B. Obtained the volumes and amounts of Advance Monthly payments to Health Plan Administrators for Calendar Years 2007, 2008, and 2009.
C. Selected a statistically valid sample of 150 individuals with payments from the population of 20,434 IRS Returns Processing Individual Master File[19] records for Tax Year 2008 cycle 200930 that had a Transaction Code 971 (Miscellaneous transaction that performs different actions based on the Action Code) with Action Code 170 (Represents an individual’s payment for the Advance Monthly Payment Option) and Action Code 171 (Represents the Government’s 65 percent portion of the individual’s monthly premium). We assessed the reliability of the Returns Processing Individual Master File by performing run-to-run balancing and reviewing a sample of 25 records against the IRS Integrated Data Retrieval System[20] and determined the data met extract criteria and were valid per IRS files. Our sample size was based on a 90 percent confidence level, a 5 percent error rate, and ±3 percent precision level. We reviewed the individuals’ Advance Monthly Payments in Calendar Year 2008 and found that the payments were timely and accurately processed.[21]
D. Matched 20,434 IRS Returns Processing Individual Master File records for Tax Year 2008 cycle 200930 that had a Transaction Code 971 (Miscellaneous transaction that performs different actions based on the Action Code) with Action Code 171 (Represents the Government’s 65 percent portion of the individual’s monthly premium) to a computer extract of the Tax Year 2008 Health Coverage Tax Credit (HCTC) Advance Payments (Form 1099-H)[22] to determine whether the amount of Federal subsidized payments on the IRS Master File[23] is the same amount as reported on the Form 1099-H. We assessed the reliability of the Returns Processing Individual Master File by performing run-to-run balancing and reviewing a sample of 25 records to the IRS Integrated Data Retrieval System and determined the data met extract criteria and were valid per IRS files. We validated the reliability of the Form 1099-H computer extract by reviewing a sample of 25 records on the Integrated Data Retrieval System to verify eligibility for the HCTC Program and to confirm payments were made on behalf of the eligible participants.
E. Obtained a list from the IRS with 3,661 transactions pertaining to the Advance Monthly Payment Option that did not post to individuals’ tax accounts. We selected a statistically valid sample of 111 transactions from the population of 3,661 unpostable transactions to determine whether a tax account existed to post a transaction. Our sample size was determined based on a 95 percent confidence level, 5 percent expected error rate, and ±4 percent precision level. For each of the 111 transactions, we used the Integrated Data Retrieval System to determine whether an individual’s entity data were on IRS files.
III. Reviewed the HCTC Program’s Health Plan Administrators on file to determine the validity of the TINs and to ascertain whether the information is consistent with IRS’ Health Plan Administrators on file.
A. Obtained
a file containing 2,671 Health Plan Administrators from the HCTC Program on November
6, 2009, and obtained a file containing 3,060 Health Plan Administrators on the
IRS’ Integrated Procurement System[24]
from the
B. Obtained a file containing 2,671 Health Plan Administrators from the HCTC Program on November 6, 2009. We matched the HCTC Program file of Health Plan Administrators to the IRS Business Master File[26] to determine the validity of the TINs. We assessed the reliability of the Business Master File data by performing a run-to-run balancing and reviewing a sample of 25 records against the IRS Integrated Data Retrieval System and determined the data met extract criteria and were valid per IRS files. We determined whether the American Recovery and Reinvestment Act of 2009 (Recovery Act)[27] changes to the Advance Monthly Payment HCTC were implemented by the dates established by the legislation.
C. Used the March 2009 Summed Vendor Payment report for the March 26, 2009, payment run and March 30, 2009, payment run and the April 2009 Summed Vendor Payment report for the April 24, 2009, payment run and the April 28, 2009, payment run to verify whether the Federal Government subsidized payment was timely changed from 65 percent of an individual’s monthly health insurance premium to 80 percent, as required by the HCTC provisions of the Recovery Act.
D. Obtained the IRS’ Wage and Investment Division Scorecard Report to determine whether the IRS met the legislated date for implementing the reimbursement of health premiums paid when eligible and enrolling in the Advance Monthly Payment Option. We secured documentation to ascertain whether a training guide had been developed and procedures established to reimburse individuals eligible for the Advance Monthly Payment Option for health insurance payments they paid during the enrollment process and reviewed documentation to determine whether a review and approval process of the reimbursement credits was performed before disbursement by the IRS. In addition, we selected a statistically valid sample of 150 individuals from a population of 4,390 individuals who submitted claims for reimbursement credits from September 1, 2009, through January 31, 2010. Our sample size was determined based on a 95 percent confidence level, 50 percent expected error rate, and ±8 percent precision level. We reviewed reimbursement claims with supporting proof of payment and reimbursement credit details to determine whether the claims were timely and accurately processed.[28]
IV. Interviewed HCTC Program management and obtained documentation to determine whether the IRS has a process to provide customer service to individuals participating in the Advance Monthly Payment Option and how the IRS tracks and monitors these individuals’ issues with the Advance Monthly Payment Option.
Internal controls
methodology
Internal controls relate to management’s
plans, methods, and procedures used to meet their mission, goals, and
objectives. Internal controls include
the processes and procedures for planning, organizing, directing, and
controlling program operations. They
include the systems for measuring, reporting, and monitoring program
performance. We determined the following
internal controls were relevant to our audit objective: the Recovery Act; Internal Revenue Manual; Standards for Internal Control in the
Federal Government;[29] and HCTC Program policies, procedures, and
practices for the Advance Monthly Payment Option. We evaluated these controls by interviewing
management, reviewing applicable information, analyzing advance payment data on
the Master File and Form 1099-H, reviewing a sample of Advance Monthly Payments,
and examining Health Plan Administrator information.
Appendix II
Major Contributors to This Report
Michael E. McKenney, Assistant Inspector General for Audit (Returns
Processing and Account Services)
Russell P. Martin, Director
Edward Gorman, Audit Manager
Gwendolyn Gilboy, Lead Auditor
Karen Fulte, Senior Auditor
Denise M. Gladson, Auditor
LaToya Penn, Auditor
Marcus D. Sloan, Auditor
Richard Hillelson, Information Technology
Specialist
Appendix III
Commissioner C
Office of the Commissioner – Attn: Chief of Staff C
Deputy
Commissioner for Services and Enforcement
SE
Deputy Commissioner, Wage and Investment Division SE:W
Director, Electronic Tax Administration and Refundable Credits, Wage and Investment Division SE:W:ETARC
Acting Program Manager, Health Coverage Tax Credit, Wage and Investment Division SE:W:HCTC
Chief Counsel CC
National Taxpayer Advocate TA
Director,
Office of Legislative Affairs CL:LA
Director, Office of Program Evaluation and Risk Analysis RAS:O
Office of Internal Control OS:CFO:CPIC:IC
Audit
Liaison: Chief,
Program Evaluation and Improvement, Wage and Investment Division SE:W:S:PRA:
Appendix IV
Health Coverage Tax Credit (Form 8885)
The Form was removed
due to its size. To see the Form, please
go to the Adobe PDF version of the report on the TIGTA Public Web Page.
Appendix V
Role of Each Location in the Health Coverage Tax
Credit Program
·
The Headquarters office
in
·
The
·
The
·
The
U.S. Bank in
·
The contractor’s
(Accenture) Finance and Accounting office is comprised of two sections: General Accounting and Reporting/Systems
Control and Health Plan Administrator Outreach/Case Management. This office is responsible for all
accounting, payment processing, and vendor-related activities, such as
participant account maintenance; Health Plan Administrator interactions and
account maintenance; vendor set-up in the IRS financial system; Health Plan
Administrator returned funds and bulk premium changes; and reconciliation of the
HCTC general ledger.
·
The HCTC Program
plans to move all accounting and financial activities for the Advance Monthly Payment
Option from
·
The
·
The HCTC
server is physically located in
·
This site provides a place for receipt of data from an external HCTC system[33] and transmission of data to an external HCTC system.
Appendix VI
The Health Coverage Tax Credit (HCTC) Reimbursement Request
(Form 14095)
The Form was removed
due to its size. To see the Form, please
go to the Adobe PDF version of the report on the TIGTA Public Web Page.
Appendix VII
Management’s Response to the Draft Report
DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE
COMMISSIONER
WAGE AND
INVESTMENT DIVISION
September 2, 2010
MEMORANDUM FOR MICHAEL R. PHILLIPS
DEPUTY INSPECTOR GENERAL FOR AUDIT
FROM: for Richard Byrd Jr. /s/ Peggy Bogadi
Commissioner, Wage and Investment Division
SUBJECT” Draft
Audit Report – Health Coverage Tax Credit Recovery Act Provisions Were Timely Implemented,
but Program Capacity Is Limited (Audit # 201040106)
We have reviewed the subject draft report and
appreciate your review of the IRS Health Coverage Tax Credit (HCTC) Program and
our implementation of the American Recovery and Reinvestment Act of 2009 (Recovery
Act) provisions. We appreciate your acknowledgement that the HCTC Program Office
ensures accurate and timely processing of payments; timely and accurately implemented
provisions of the Recovery Act; and participation in the Monthly Credit Option
has increased since the Recovery Act provisions took effect.
The IRS has administered the HCTC Program since
it was created in 2002. The tax credit is designed to provide assistance paying
for health insurance to a select group of individuals who might otherwise be
uninsured. For eligible taxpayers, the HCTC makes health care insurance more,
affordable by paying a substantial portion of their health insurance premiums.
The HCTC Recovery Act provisions included increasing
the HCTC portion of health premiums paid from 65 to 80 percent, reimbursing the
taxpayers’ portion of premiums paid during the enrollment period allowing family
members to continue receiving benefits after certain life events; and expanding
taxpayer eligibility in the Program. Effective implementation of these provisions
was critical to provide taxpayers the benefits mandated by the Recovery Act.
Attached are our specific comments on your recommendations.
If you have any questions, please contact me, or a member of your staff may
contact Rinaldi Boykin, Acting Program Manager, Health Coverage Tax Credit
Office, at (202) 283-9600.
Attachment
Attachment
The Commissioner, Wage and Investment Division,
should:
RECOMMENDATION
1: Develop a process to
ensure Health Plan Administrators reflected on the HCTC systems are consistent
with those reflected on the IRS systems. This should include ensuring Health
Plan Administrators are consistently listed on the IRS financial system and the
HCTC financial system and Health Plan Administrators TINs are valid.
CORRECTIVE
ACTION
We agree with this recommendation. A joint
effort by the Beckley Finance Center (BFC) staff and the Health Coverage Tax
Credit (HCTC) Payments Processing Team, to review, analyze, and correct discrepancies
between the Integrated Financial System (IFS) and HCTC system, was launched
August 2, 2010.
Also, the HCTC Payments Processing Team and
the BFC staff will conduct joint quarterly quality reviews of HCTC and IFS
vendor extracts to ensure both systems accurately reflect the same data. Any
discrepancies will be worked jointly to ensure data integrity between the two
systems.
IMPLEMENTATION
DATE
October 15.2010
RESPONSIBLE
OFF ICIAL
Program Manager, Health Coverage Tax Credit
Office, Wage and Investment Division Funds Management Section, Beckley Finance
Center
CORRECTIVE
ACTION MONITORING PLAN
We will monitor this corrective action as part
of our internal management control system.
RECOMMENDATION
2: Develop a process to
ensure individuals participating in the Advanced Monthly Payment Option receive
accurate Health Coverage Tax Credit (HCTC) Advance Payments (Form 1099-H)
payment information.
CORRECTIVE
ACTION
We disagree with this recommendation because
individuals participating in the Advanced Monthly Payment Option do receive
accurate Form 1099-H (Health Coverage Tax
Credit (HCTC) Advance Payments)
payment information, Data contained on Form 1099-H is for information only. If
payment information is updated or changed, a corrected Form 1099-H is issued to
the taxpayer and to the IRS. All IRS HCTC
systems correctly reflect accurate payment data.
IMPLEMENTATION
DATE
N/A
RESPONSIBLE
OFFICIAL
N/A
CORRECTIVE
ACTION MONITORING PLAN
N/A
RECOMMENDATION
3: Develop a process to identify and resolve
unpostable records to ensure eligibility indicators are added to individuals’
tax accounts.
CORRECTIVE
ACTION
We agree with this recommendation; however,
additional corrective action is not necessary. We submitted a Unified Work Request
that was approved by Modernization and Information Technology Services for Tax
Year 2011, to identify unpostable transactions and generate a report. This report
will be used to manually post these transactions to the Master File.
IMPI.EMENTATION
DATE
Completed
RESPONSIBLE
OFFICIAL
Program Manager, Health Coverage Tax Credit
Office, Wage and Investment Division
CORRECTIVE
ACTION MONITORING PLAN
N/A
[1] Pub. L. No. 111-5, 123 Stat. 115 (2009).
[2] Pub. L. No. 107-210, 116 Stat.933 (2002).
[3] For this type of tax credit, the taxpayer can receive a refund even if they did not owe any taxes or earn any income.
[4] When an employer cannot continue paying pensions to its retirees, the PBGC may be requested to take over the responsibility of paying pension benefits to the employer’s retirees.
[5] This is the number of payments sent to Health Plan Administrators for individuals that participate in the Advance Monthly Payment Option.
[6] This consists of the individual’s payment for his or her share of the health premium, the Federal Government subsidized payment, and the individual’s payment for other health premiums (e.g., dental or vision benefits that are not part of the individual’s comprehensive health plan) that together pay in full the individual’s monthly health premium.
[7] Pub. L. No. 111-5, 123 Stat. 115 (2009).
[8] These steps are performed by a contractor for the IRS.
[9] See Appendix VI for an example of Form 14095.
[10] The HCTC Program Kit has the Monthly HCTC Registration Form and the Reimbursement Request Form.
[11] The HCTC Program has a financial system that maintains financial and health plan data for HCTC participants enrolled in the Advance Monthly Payment Option and a customer management system that maintains case related data for HCTC participants.
[12] Pub. L. No. 111-148, 124 Stat. 119
(2010).
[13] Pub. L. No. 111-152, 124 Stat. 1029
(2010).
[14] The IRS financial system is a commercial-off-the-shelf software package, designated as the Integrated Financial System.
[15] A TIN is a nine-digit number assigned to taxpayers for identification purposes. Depending upon the nature of the taxpayer, the TIN is an Employer Identification Number, a Social Security Number, or an Individual TIN.
[16] The HCTC system is an IRS system outside of the IRS network and maintained by contractors.
[17] Form 1099-H is used to report advance payments from the Department of the Treasury (Government portion) on behalf of eligible individuals.
[18] The customer management system maintains eligibility, payment history, policy, health plan, and case-related data for all HCTC participants.
[19] The IRS database that maintains transactions or records of individual tax accounts.
[20] IRS computer system capable of retrieving or updating stored information. It works in conjunction with a taxpayer’s account records.
[21] We reviewed only 90 of the 150 individuals with payments in Calendar Year 2008 because the HCTC Program management could not provide documentation for the remaining individuals due to the burden on the HCTC Program’s limited resources.
[22] Form 1099-H is used to report advance payments from the Department of the Treasury (Government portion) on behalf of eligible individuals.
[23] The IRS database that stores various types of taxpayer account information. This database includes individual, business, and employee plans and exempt organizations data.
[24] The IRS procurement system, designated as the Integrated Procurement System, is used to track obligations, create solicitations and awards, handle vendor files, and generate reports.
[25] The IRS financial system is a commercial off-the-shelf software package, designated as the Integrated Financial System.
[26] The IRS database that consists of Federal tax-related transactions and accounts for businesses. These include employment taxes, income taxes on businesses, and excise taxes.
[27] Pub. L. No. 111-5, 123 Stat. 115 (2009).
[28] We reviewed only 74 of the 150 individuals with submitted claims for reimbursement credits from September 1, 2009, through January 31, 2010, because the HCTC Program management could not provide documentation for the remaining individuals due to the burden on HCTC’s limited resources.
[29] GAO/AIMD-00-21.3.1, dated November 1999.
[30] The U.S. Bank in
[31] Financial Controls Over the Health Coverage Tax Credit Advance Payment Process Need to be Enhanced (Reference Number 2006-10-085, dated May 26, 2006).
[32] Health Plan Administrators mail checks to the lockbox site with a notation that the monies should be applied to the billion account number. These checks are deposited to the billion account and held there until research is performed by the HCTC Program to determine the proper application of the monies.
[33] The HCTC system is an IRS system comprised of two network systems that are outside of the IRS network and maintained by contractors.