Crackdown on ACA Fraud
In a significant move against fraud, the Department of Health and Human Services (HHS) under the Trump administration has reportedly uncovered millions of suspected fraudulent activities related to the Affordable Care Act (ACA), as detailed in a recent report.
Following a notable increase in ACA enrollment during the Biden administration, officials recognized the need to verify a surge in claims. At the onset of Biden’s presidency, about 10 million individuals were enrolled in government health programs, but that number soared to 22 million by 2024.
To date, nearly 3 million fraudulent accounts have been cut, leaving around 2.6 million that are still under scrutiny.
Officials noted that the extent of the fraudulent activities could account for as much as $10 billion lost to taxpayers from 2021 through 2024.
Interestingly, the Biden administration has eased eligibility checks and income verifications while expanding enrollment options. Reports suggest that some individuals misrepresented their incomes intentionally, and some insurance brokers unwittingly participated in what’s termed “phantom enrollment,” leading to subsidies awarded incorrectly.
According to estimates, the height of inappropriate admissions peaked in 2025 with 5.6 million suspected false entries. It’s believed there are still around 2.6 million questionable registrations, including more than a million lacking Social Security numbers.
Since these findings emerged, the Trump administration has implemented stricter income verification, retracted special enrollment options, addressed duplicate Medicaid enrollments, and looked into suspicious enrollments attributed to brokers engaging in fraud.
Currently, approximately 19.2 million people continue to be enrolled in ACA programs.
The integrity of the ACA exchanges is crucial for safeguarding taxpayer dollars for those genuinely in need, as stated in the report. It highlights that the federal government will not compensate brokers for enrolling individuals without their consent.
The Trump administration maintains a firm stance against fraud, pledging to enhance regulations and pursue investigations into improper registrations while holding accountable those brokers committing fraud.
For those interested, a full report is linked below.
