House Republicans call for investigation into Affordable Care Act enrollment fraud

A report from a conservative think tank found that as many as 5 million people are wrongfully receiving Affordable Care Act insurance subsidies, prompting House Republican leaders to call for an investigation into possible enrollment fraud.

Allegations that insurance brokers are fraudulently signing up customers into ACA health plans stem from about 90,000 complaints of unauthorized sign-ups or plan switches to the Centers for Medicare and Medicaid Services in just the first quarter of 2024. KFF Health News found that brokers falsified information to enroll customers or wrongly switch customers between plans without their consent, motivated by commissions.

The House Energy and Commerce, Ways and Means, and Judiciary Committees requested Friday that the Government Accountability Office and the inspector general at the Department of Health and Human Services investigate for fraud.

“The scale 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, requesting a “systemic review of enrollment” from the watchdogs.

The Paragon Health Institute report found a likelihood of fraud by comparing the census estimates on the number of Americans that are potentially eligible for subsidies to the actual numbers of ACA enrollment.

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During the presidential debate on Thursday, President Joe Biden highlighted that more than 40 million Americans are covered now through the Affordable Care Act and Medicaid expansions. However, Republicans are wary that the program’s purpose has become distorted.

With the introduction of the American Rescue Plan Act and the Inflation Reduction Act, enhanced subsidies have allowed those living below the poverty line to have a zero-premium plan. Around half the people who signed up for private health insurance in the recent ACA enrollment period qualified for a fully subsidized plan, up by one-third since before the enhanced subsidies.