Becker's Healthcare December 4, 2025
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...
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