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The Democrats took control of the U.S. House in 2018 and the Government Accountability Office abruptly stopped disclosing their PPACA fraud investigation results. Now, 8 years later, the GAO is back investigating Obamacare for health care fraud. It is not a pretty picture:
https://www.gao.gov/products/gao-26-108742
Obamacare subsidies granted without documentation to 90% of fake accounts set up by government watchdog
By Victor Nava - December 3, 2025Affordable Care Act subsidies have been granted, without the required documentation, to 90% of fictitious applicants over the last two years, according to a damning government watchdog report released Wednesday.
The Government Accountability Office’s (GAO) preliminary findings of ongoing and covert testing of Obamacare found “fraud risks” in the federal ACA marketplace, specifically related to the healthcare program’s advance premium tax credit – a subsidy Democrats shut down the government over last month in a failed effort to extend the tax credit for three more years.
“The federal Marketplace approved coverage for nearly all of GAO’s fictitious applicants in plan years 2024 and 2025, generally consistent with similar GAO testing in plan years 2014 through 2016,” according to the government watchdog.
The GAO found evidence that fraudsters were using the same Social Security number to enroll in multiple ACA plans and extract more taxpayer-funded subsidies.
In plan year 2024, all four of GAO’s fake applicants received coverage with lower monthly premiums – thanks to $2,350 per month in Obamacare subsidies granted to insurers – despite not submitting “documentation to support Social Security numbers (SSN), citizenship, and reported income.”
The GAO upped the number of fake applicants to 20 in plan year 2025 and 18 still “remain actively covered as of September 2025.”
The subsidies that the 18 fake enrollees were approved for totaled “over $10,000 per month.”
Evidence of potential “misuse” of Social Security numbers, including dead people receiving coverage, was also discovered by the GAO.
In plan year 2023 alone, one Social Security number was used to receive subsidized insurance coverage “for over 26,000 days (over 71 years of coverage) across over 125 insurance policies.”
In 2024, 66,000 Social Security numbers were linked to more than a years’ worth of subsidized coverage.
GAO also compared Social Security numbers of the deceased to those that received tax credits and in 2023 and identified over 58,000 matches, including at least 7,000 people who died before coverage began.
The report explained that the Centers for Medicare and Medicaid Services, which oversees the federal marketplace for Obamacare, doesn’t bar a Social Security number already used for an enrollment to be used again – in order to allow people to get coverage in instances where identity theft takes place.
Top Republican lawmakers described the report as the “smoking gun” proving their claims that Obamacare is “broken.”
“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,” House Ways and Means Committee Chairman Jason Smith (R-Mo.) said in a statement.
The GAO investigation was requested by Smith along with Energy and Commerce Committee Chairman Brett Guthrie (R-Ky.) and Judiciary Committee Chairman Jim Jordan (R-Ohio).
“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,” Guthrie said in a statement.
“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.”
Jordan said the 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,” the Ohio Republican added.
As part of deal Senate Democrats struck with Senate Majority John Thune (R-SD) last month to reopen the government, the upper chamber is expected to take up a vote on extending the pandemic-era ACA tax credit, which is currently set to expire at the end of the year.
The full GAO report runs 26 pages. Here are their very carefully worded highlights:
https://www.gao.gov/products/gao-26-108742
https://www.gao.gov/assets/gao-26-108742.pdf
Patient Protection and Affordable Care Act:
Preliminary Results from Ongoing Review Suggest Fraud Risks in the Advance Premium Tax Credit Persist
GAO-26-108742
Published: December 03, 2025. Publicly Released: December 03, 2025.Highlights
What GAO Found
Preliminary results from GAO's ongoing covert testing suggest fraud risks in the advance premium tax credit (APTC) persist. The federal Marketplace approved coverage for nearly all of GAO's fictitious applicants in plan years 2024 and 2025, generally consistent with similar GAO testing in plan years 2014 through 2016. GAO's covert testing is illustrative and cannot be generalized to the enrollee population.
- Plan year 2024. The federal Marketplace approved subsidized coverage for all four of GAO's fictitious applicants submitted in October 2024. In total, the Centers for Medicare & Medicaid Services (CMS) paid about $2,350 per month in APTC in November and December for these fictitious enrollees. For some, the federal Marketplace requested documentation to support Social Security numbers (SSN), citizenship, and reported income. GAO did not provide documentation yet received coverage.
- Plan year 2025. Of 20 fictitious applicants, 18 remain actively covered as of September 2025. APTC for these 18 enrollees totals over $10,000 per month. GAO continues to monitor the enrollments as part of its ongoing work.
More broadly, GAO's preliminary analyses identified vulnerabilities related to potential SSN misuse and likely unauthorized enrollment changes in federal Marketplace data for plan years 2023 and 2024. Such issues can contribute to APTC that is not reconciled through enrollees' tax filings to determine the amount of premium tax credit for which enrollees were ultimately eligible. GAO's preliminary analysis of data from tax year 2023 could not identify evidence of reconciliation for over $21 billion in APTC for enrollees who provided SSNs to the federal Marketplace for plan year 2023. Unreconciled APTC may not necessarily represent overpayments, as enrollees who did not reconcile may have been eligible for the subsidy. However, it may include overpayments for enrollees who were not eligible for APTC.
Overused SSNs. GAO's preliminary analyses identified over 29,000 SSNs in plan year 2023 and nearly 68,000 SSNs in plan year 2024 used to receive more than one year's worth of insurance coverage with APTC in a single plan year. CMS officials explained that the federal Marketplace does not prohibit multiple enrollments per SSN to help ensure that the actual SSN-holder can enroll in insurance coverage in cases of identity theft or data entry errors.
GAO's preliminary analyses also identified at least 30,000 applications in plan year 2023 and at least 160,000 applications in plan year 2024 that had likely unauthorized changes by agents or brokers. This can result in consumer harm, including loss of access to medications. In July 2024, CMS implemented a new control to prevent such changes, which GAO is reviewing in its ongoing work.GAO preliminarily identified weaknesses in CMS’s APTC fraud risk management as compared to leading practices. Specifically, CMS has not updated its fraud risk assessment since 2018 despite changes in the program and its controls. Further, CMS’s 2018 assessment may not fully align with leading practices, like identifying inherent fraud risks. Finally, CMS did not use its 2018 assessment to develop an antifraud strategy. Together, these weaknesses appear to hinder CMS’s ability to effectively and proactively manage fraud risks in APTC.
Why GAO Did This Study
The Patient Protection and Affordable Care Act provides premium tax credits to help eligible individuals pay for health insurance. The federal government can pay this credit directly to health insurance issuers as APTC. CMS estimated that it paid nearly $124 billion in APTC for about 19.5 million enrollees in plan year 2024. Consumers can enroll in insurance through the federal Marketplace independently or with assistance from an agent or broker.
Recent indictments highlight concerns about agent and broker practices in the federal Marketplace. Further, CMS reported that it received roughly 275,000 complaints in 2024 that consumers were enrolled or had insurance plans changed in the federal Marketplace without their consent.
GAO was asked to review issues related to fraud risk management in APTC. This report discusses preliminary results of ongoing GAO work related to (1) covert testing and (2) data analyses of enrollment controls in the federal Marketplace, as well as (3) CMS's APTC fraud risk assessment and antifraud strategy.
To perform this work, GAO created 20 fictitious identities and submitted applications for health care coverage in the federal Marketplace for plan years 2024 and 2025. The results, while illustrative, cannot be generalized to the full enrollment population. Additionally, GAO analyzed federal Marketplace enrollment data for plan years 2023 and 2024 and compared these data to federal death data and tax data. Finally, GAO assessed documentation related to CMS's fraud risk management activities against relevant leading practices.
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