The Patriot Post® · ObamaCare Fraud and the Way Forward
ObamaCare has done nothing to help with healthcare or make it affordable and has done everything to increase healthcare costs for Americans, and open the door wide for fraud. If the exposed Somali Medicaid fraud wasn’t enough, other reports have also been pouring in.
The Congressional Budget Office has identified millions of potentially erroneous or fraudulent enrollees receiving tens of billions of dollars in taxpayer-funded subsidies. The Government Accountability Office (GAO) released its report last week, shedding more light on the system’s abuses. Here are some of the key findings reported by health policy expert Chris Jacobs:
As of April 2025, enrollees receiving over $21 billion in subsidies — or about 32 percent of subsidies paid on behalf of enrollees who submitted a Social Security number to the federal Exchange in 2023, the most recent year for which data is available — failed to reconcile the subsidies (which are paid in advance of tax filings) they received in 2023 with their actual income by filing a 2023 tax return (normally due April 15, 2024). While there could be an innocent reason why these enrollees did not file a return, it also means that enrollees who (deliberately or otherwise) received more in subsidies than they were entitled to based on their actual income have yet to pay their “extra” subsidy dollars back.
More than 29,000 Social Security numbers in 2023, and almost 66,000 Social Security numbers in 2024, reported more than 365 days of subsidized insurance coverage, indicating potential fraud associated with those Social Security numbers. In one instance, a single Social Security number was linked to more than 26,000 days (more than 71 years) of subsidized insurance coverage “across over 125 insurance policies” in 2023.
In 2023, a total of 58,000 Social Security numbers received subsidies yet also matched Social Security Administration death data. These instances included more than 7,000 numbers “where the reported date of death occurred prior to enrollment” in the Exchange, and more than 19,000 numbers where “matches had different names and dates of birth” between the Exchange database and the Social Security Administration database, a potential sign of “synthetic identity fraud.”
At least 30,000 applications in 2023 and at least 160,000 applications in 2024 “had likely unauthorized changes” made by agents or brokers who engaged in “potential misconduct … seeking to maximize commissions” they would receive for enrolling people in Exchange coverage. GAO cited one real-life example (anonymized in the report) whereby a single individual had his coverage changed 15 separate times by 10 different brokers in a single eight-day span in late 2023.
The GAO also confirmed what the Congressional Budget Office found: it was all too easy to apply for and receive ObamaCare subsidies, even with fake identification documents. Investigators submitted 24 phony applications for ObamaCare subsidies in the past two years, and all but one were approved.
The Washington Journal highlights The Paragon Health Institute's Brian Blase’s information on the matter: “Using Census Bureau data, Mr. Blase estimates that about 6.4 million people this year were improperly enrolled in subsidized ObamaCare plans, costing taxpayers $27 billion. He has also found that about 40% of enrollees in plans fully subsidized by the government filed no medical claims. GAO’s report suggests many may not be real people. Others may have employer coverage and been enrolled by brokers without their knowledge.”
The most widespread issue is that some brokers and insurers are exploiting a poorly designed system to line their own pockets. The most common fraud situation seems to be that people are being signed up for plans without their knowledge. They either don’t want insurance or already have coverage, but brokers signed them up for fully subsidized plans. As a result, the subsidies are being transferred directly from the government to the insurance company.
If all of this isn’t enough evidence to end ACA tax credits and get the medical industrial complex out of politicians’ pockets, I don’t know what is.
What should be obvious is the need for sweeping reforms to ObamaCare, or, better yet, ditching it entirely. This year’s GOP tax bill included modest reforms to prevent ObamaCare fraud, such as requiring the exchange to verify Social Security numbers and income data before enrolling applicants in plans. It also requires people to repay the government if their incomes turn out to be higher than what they estimated on their applications. These are a start, but it’s not enough. As The Washington Post’s editorial board points out, “Any serious effort to extend Obamacare subsidies would need to include lower income caps, require some out-of-pocket premiums and impose additional anti-fraud protections.”
America can’t afford ObamaCare. It was sold to taxpayers on false pretenses, and until the subsidies stop, the fraud and abuse will not.