The U.S. Government Accountability Office found significant fraud risk in the ACA application process, according to a Dec. 3 agency report.
Auditors applied for coverage under fictitious identities to test marketplace enrollment controls. The marketplace approved coverage for the four fictitious applicants from November through December 2024, with advance premium tax credits totaling about $2,350 per month.
“While our fictitious enrollees are not generalizable to the universe of enrollees, they suggest weaknesses in enrollment controls — such as identity proofing and income verification — in the federal marketplace,” the report said.
Looking at plan year 2023 data, GAO found more than 58,000 Social Security numbers received these tax credits but matched death data.
The auditors also could not confirm that enrollees who provided Social Security numbers in plan year 2023 reconciled taxes for over $21 billion in credits.
Another point of concern: In October 2024, CMS said it had received more than 90,000 complaints between January and August 2024 from consumers who experienced unexpected changes to their federal marketplace insurance plans. GAO found at least 30,000 applications in plan year 2023 and 160,000 applications in plan year 2024 with possible unauthorized changes.
CMS has not updated its fraud risk assessment since 2018.
The report could provide ammunition for Republicans amid debates over extending ACA subsidies, which are set to expire at the end of the year.
