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| Frederick Medina/UNSPLASH |
Given the persistence of eligibility fraud through 2025, CMS should make its reasoning behind last year’s broker reinstatements and this year’s subsequent terminations clear.
The Trump administration’s latest action to root out waste, fraud, and abuse in the Obamacare Exchanges entailed disenrolling people from insurance plans — costing taxpayers billions — who couldn’t identify themselves with proper documentation.It’s the kind of move that would prompt ordinary taxpayers in the heartland to ask: Why didn’t they do that sooner?
Ghost Enrollees
In a fact sheet, the federal Centers for Medicare and Medicaid Services (CMS) announced it had “canceled approximately 315,000 enrollments covering over 760,000 individuals after confirmation that these enrollments were unauthorized.” The action, taken after investigations in coordination with insurance companies, will result in approximately $2.2 billion in Obamacare subsidies being refunded to the federal government.
At the same time, CMS announced it had sent “569 notices of intent to terminate Exchange Agreements to agents and brokers that submitted 2026 applications [for coverage] without identifying applicant information, such as a Social Security number.” It said 66 of those agents and brokers had already been terminated, and more will likely follow as CMS receives responses from the relevant parties.
Questionable Enrollment Persists
CMS also published an interim final rule (i.e., one taking effect immediately) imposing a six-month moratorium on the new registration of brokers and agents, allowing CMS to implement another round of program integrity measures to guard against fraud by agents and brokers. (The moratorium will not apply in states that run their own Exchanges, which set their own rules regarding insurance brokers.) The move caused some pushback from the broker community, which said this punishes the innocent with the guilty since no new broker will be able to register until next February, after the open enrollment period for 2027.
In response, CMS cited data indicating that new agents for the current (i.e., 2026) plan year had significantly higher rates of questionable enrollment — for instance, a 2.8-time higher rate of “unresolved income verification issues,” a 2.7-time higher rate of “missing Social Security numbers,” a 2.6-time higher rate of “unresolved citizenship or immigration status verification issues,” and a 1.4-time higher rate of dual enrollment in Exchange coverage and Medicaid. To CMS, these data points suggest that new brokers may be disproportionately seeking to enroll ineligible individuals primarily for the commissions, and justified the registration moratorium as a preventive measure.
Prior Government Audit --->READ MORE HERE
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The Trump administration’s Task Force to Eliminate Fraud has claimed another victory. It recently announced that it’s removing more than 760,000 unverified “phantom” enrollees from the rolls of the Affordable Care Act (ACA), resulting in $2.2 billion in savings.This Task Force was established in March to weed out fraud across various departments and agencies. Its Fraud Ledger tracks and tallies fraud across several measures, including fraud uncovered, fraud stopped, and fraud enforced (recovered). The Department of Health and Human Services is leading the way with $96.1 billion in uncovered fraud; $46.2 billion in stopped fraud; and $32.9 billion in fraud enforcement and recovery.
The latest action by Centers for Medicare and Medicaid Services (CMS) centers on the ACA and a three-prong strategy to “prevent fraudulent and improper enrollments, remove existing unauthorized enrollments, and strengthen oversight and enforcement of agents and brokers participating in Exchanges.”
Such a crackdown is long overdue. Because the Biden administration expanded and increased the ACA subsidies during COVID, enrollment — especially in plans with no premium requirements — skyrocketed.
The Paragon Institute found that from 2020 to 2025, enrollment in the 100-150% federal poverty level income bracket (which makes them eligible for generous or complete subsidy) surged from 3 million to over 10 million. But their research also showed that since the expiration of the COVID subsidies, there remain irregularities in enrollment.
According to the Centers for Medicare and Medicaid Services, the agency has found “a pattern of unauthorized enrollments and suspicious agent and broker activity in the Federal Marketplace,” and its efforts have focused on working with health insurers to identify suspicious enrollments and those brokers and agents that assist with enrollment. As a result, CMS cancelled “approximately 315,000 enrollments covering over 760,000 individuals after confirming that these enrollments were unauthorized,” and saving federal taxpayers $2.2 billion in ACA subsidy distributions. --->READ MORE HERE
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