"CMS's internal controls did not effectively ensure the accuracy of nearly $2.8 billion in aggregate financial assistance payments made to insurance companies under the Affordable Care Act during the first 4 months that these payments were made.... We recommended that CMS correct these internal control deficiencies by requiring its Office of the Actuary to review and validate QHP issuers' actuarial support for index rates that CMS identifies as outliers, implementing computerized systems to maintain confirmed enrollee and payment information so that CMS does not have to rely on QHP issuers' attestations in calculating payments, implementing a computerized system so State marketplaces can submit enrollee eligibility data, following its guidance for calculating estimated advance CSR payments, and developing interim reconciliation procedures to address potentially inappropriate CSR payments."  MORE >>