A new report from the Government Accountability Office (GAO) has identified significant fraud in Affordable Care Act (Obamacare) Marketplace plans, resulting in billions of taxpayer dollars wasted and harm to consumers. The findings were released following an investigation requested by Congressmen Jason Smith of Missouri, Brett Guthrie of Kentucky, and Jim Jordan of Ohio.
U.S. Senator Mike Crapo (R-Idaho), Chairman of the Senate Finance Committee, commented on the report’s findings: “The GAO’s findings further illustrate the brokenness of Obamacare. The temporary, enhanced COVID-era credits have exacerbated Obamacare’s structural failures, causing fraud to explode and leaving taxpayers to subsidize criminals and shady insurance brokers. Premiums and out-of-pocket costs are rising for all Americans, but as we look for ways to improve the health care system, this investigation serves as a stark reminder that we cannot simply throw good money after bad policy.”
The GAO conducted its investigation by creating fake identities and attempting to enroll them in advance premium tax credits (PTCs), which are subsidies provided under Obamacare. In 2024, all four fake applicants created by GAO were approved for subsidies; in 2025, 18 out of 20 fake applicants were receiving subsidies as of September. Some enrollees used falsified proof of income, Social Security numbers, or citizenship status; others were approved without submitting any documents.
The report highlighted several risks:
– Identity theft: In 2024 alone, 66,000 Social Security numbers were enrolled in multiple plans. One Social Security number was used across 125 different policies in 2023—equivalent to receiving credits over a span of 71 years. Additionally, $94 million in subsidies went to plans created with Social Security numbers belonging to deceased individuals.
– Unauthorized changes: Insurance brokers made likely unauthorized changes on about 160,000 applications for PTCs in 2024. Over an eight-month period, more than 270,000 complaints were filed with the Centers for Medicare and Medicaid Services from Americans who had been enrolled or switched into unwanted plans.
– Credit overpayment: Nearly one-third of PTCs paid in 2023 had not been reconciled against enrollees’ actual income levels. This gap allows individuals to potentially receive larger subsidies by misreporting their income at enrollment.
Related reports from congressional committees also highlight concerns about consumer harm and large-scale waste due to health care fraud within Affordable Care Act plans through oversight investigations available at the U.S. House Committee on Ways and Means website and statements from the U.S. House Committee on Energy and Commerce.
