The Center for Consumer Information & Insurance Oversight
Advance Payments of the Premium Tax Credit (APTC) Audits
Sections 1401 of the Patient Protection and Affordable Care Act (ACA) established the Advance Payments of the Premium Tax Credit (APTC) program to lower the monthly premium for eligible individuals.
Regulations at 45 CFR §§ 156.480, 156.705, and 156.715 allow the Department of Health and Human Services (HHS) to conduct audits of issuers that offer a Qualified Health Plan (QHP) in the individual market through an Exchange to assess compliance with the APTC and FFE user fee program requirements. The goals of these audits are to:
- Safeguard Federal funds;
- Instill confidence in payment data quality among regulated entities;
- Evaluate health insurance issuer compliance with program rules and regulations; and
- Efficiently use taxpayer resources while minimizing the unnecessary burdens on issuers and consumers.
CMS APTC Audit Reports
The CMS APTC Audit program commenced in 2017 with review of data reported for the 2014 FFE reporting year. This page contains CMS APTC reports that are organized by the reporting year. Reports will be uploaded as each audit year is completed for each audit type.