House Republicans call for investigation into Affordable Care Act enrollment fraud

A report by a conservative think tank found that up to five million Americans improperly received subsidies under the Affordable Care Act, prompting House Republican leaders to call for an investigation into enrollment fraud.

The allegations that insurance brokers fraudulently enroll customers in ACA health insurance plans follow about 90,000 complaints of unauthorized enrollments or plan switches filed with the Centers for Medicare and Medicaid Services in the first quarter of 2024 alone. KFF Health News found that brokers falsified information to enroll customers or falsely switched customers between plans without their consent, motivated by commissions.

The House Energy and Commerce Committee, the Budget Committee and the Judiciary Committee on Friday called on the Government Accountability Office and the Inspector General of the Department of Health and Human Services to launch fraud investigations.

“The magnitude of the problem suggests malicious intent,” Reps. Cathy McMorris-Rodgers (R-WA), Jason T. Smith (R-MO) and Jim Jordan (R-OH) wrote in their letters, calling on regulators to “systematically review enrollment.”

The Paragon Health Institute report concluded that fraud is likely. The report compares census estimates of the number of Americans potentially eligible for subsidies with the actual number of ACA enrollees.

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During Thursday’s presidential debate, President Joe Biden emphasized that more than 40 million Americans are now covered by the Affordable Care Act and Medicaid expansion, but Republicans are concerned that the purpose of the program has been distorted.

With the introduction of the American Rescue Plan Act and the Inflation Reduction Act, increased subsidies have made it possible for people living below the poverty line to purchase a plan with no premiums. About half of people who signed up for private health insurance during the last ACA enrollment period were eligible for a fully subsidized plan, up one-third from before the increased subsidies.