New report finds billions of taxpayer dollars wasted due to fraud in Affordable Care Act plans
Estimates show millions of improper enrollments, costing taxpayers up to $27B annually
Washington, D.C. – The non-partisan Government Accountability Office (GAO) released a new report uncovering massive waste, fraud, and abuse in the Affordable Care Act marketplace plans. GAO investigators, using fake identities with no valid Social Security numbers or proof of citizenship, were approved for advance premium tax credits (APTC). Monthly subsidies paid to health insurers on behalf of GAO’s fake identities exceeded $12,300 per month—revealing how easily the system can be exploited.
“This investigation exposed that the scale of fraud in the ACA marketplace is egregious, and it’s driving up costs for Americans who properly enroll,” Fedorchak said. “Republicans are leading on commonsense safeguards to protect taxpayers and stop the exploitation that Democrat policies have enabled.”
Key findings from the GAO investigation:
Investigators created fake applicants that were repeatedly approved for taxpayer-funded benefits, even when no identification documents were requested or fake documents were submitted.
Every single fake applicant was approved by the ACA Marketplace as recently as late 2024.
90 percent of GAO’s fake applicants are still receiving coverage in 2025.
In 2023, one single Social Security number was used on applications for over 125 insurance policies, the equivalent of 71 years of health insurance coverage.
58,000 Social Security numbers receiving APTC matched Social Security death data.
$94 million in taxpayer-funded subsidies were sent to health insurers on behalf of deceased individuals.
Why it matters:
The use of fake citizenship eligibility documents confirms fraud concerns for illegal immigrants.
Insurance brokers were able to bypass verification by contacting the call center and submitting applications without the applicant present. People can be enrolled in plans without their knowledge while insurance companies collect tax credits.
CMS does not block new applications using the same SSN.
Big Insurers are still collecting subsidies for deceased individuals.
In the Working Families Tax Cuts Act, Republicans passed solutions to restore accountability to the ACA marketplace through program integrity reforms that save taxpayers billions of dollars and drive down costs:
Full income and eligibility verification before subsidies are issued, ensuring assistance goes only to those who qualify.
Ending “anytime” enrollment abuse that fueled fraudulent sign-ups and drove premiums higher.
Closing loopholes that allowed illegal immigrants and other ineligible groups to access taxpayer-funded health benefits.
The Congressional Budget Office has found that these measures have already produced $185 billion in savings for taxpayers and reduced premiums by 0.6 percent.
Congressman Brett Guthrie (R-KY), Chairman of the House Committee on Energy and Commerce:
“Republicans have consistently prioritized protecting patients and taxpayers by ridding our federal health programs of the waste, fraud, and abuse that ultimately drive up costs for patients. Republicans have sounded the alarm on the flawed structural integrity of Obamacare and how Democrats’ failed policies to temporarily prop up the program have exacerbated fraud, hurt patients, increased the burden on American taxpayers, and artificially masked the true health care affordability crisis plaguing Americans today. The concerning findings from GAO’s report further confirm that Republican efforts to strengthen, secure, and sustain our federal health programs are critical and necessary to ensure access to quality health care at prices Americans can afford.”
Congressman Jason Smith (R-MO), Chairman of the House Committee on Ways and Means:
“While Democrats defend waste, fraud, and abuse, Republicans are taking action to lower health care costs and protect care for all real, living Americans. GAO’s troubling report is the smoking gun that shows how this broken system, shielded by Democrat policies, has led to the federal government shoveling tens of billions of tax dollars to insurance companies through identity fraud and caused health care costs to skyrocket for all Americans. While Obamacare fraud is being confirmed by GAO, CMS, CBO and other outside reports, patients are suffering. They face higher health care costs and denied claims or delayed care when their providers struggle to verify which insurance is valid due to these fraud schemes. Rather than simply rubber stamp more bad spending and failed policies, we must take action to prevent further harm.”
Congressman Jim Jordan (R-OH), Chairman of the House Committee on the Judiciary:
“For years, we were told we could keep our plan, keep our doctor, and premiums would go down. None of it happened. This new report confirms what we already knew: under Obamacare, hardworking Americans saw their premiums skyrocket and their healthcare choices shrink, all while fraud benefitted insurance companies. Obamacare was built on lies and broken promises that hurt families and drove up costs."
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