Was surprised it wasn’t breaking news somewhere …

Fake Obamacare accounts got $2,350/month from US taxpayers, watchdog finds. Why experts say it’s no bombshell
Bombshell, or bust? That’s the question hanging over a recent preliminary report from the Government Accountability Office about Affordable Care Act subsidy fraud.

The nonpartisan watchdog’s report (1), which dropped in early December, is based in part on findings from 2024 and 2025 during which time the Government Accountability Office (GAO) employed “fictitious applicants” to apply for the Affordable Care Act (ACA) advance premium tax credit (APTC) — a federal subsidy program that pays directly to insurance companies to help lower individual premiums on Marketplace plans.

They found that, in 2024, the Centers for Medicare & Medicaid Services (CMS) paid subsidies for all four of their fake applicants, totaling roughly $2,350 a month — despite some of those “applicants” failing to provide citizenship documentation or Social Security numbers (SSNs). In 2025 the GAO enrolled 20 fake applicants with the CMS — 18 of which still receive APTCs that combine for more than $10,000 a month.

In addition, the report found that a total of 29,000 SSNs received “more than one year's worth of insurance coverage with APTC in a single plan year” in 2023, with another roughly 66,000 doing the same in 2024, meaning the same SSNs were used multiple times to receive benefits.
The findings also showed that brokers or insurance agents likely changed, without authorization, 30,000 or more coverage applications in 2023 and 160,000 in 2024, which “can result in consumer harm, including loss of access to medications.”

The GAO report was requested by three Congressional Republicans who released a statement (2) saying that it demonstrates “rampant waste, fraud, and abuse,” with Judiciary Committee Chairman Jim Jordan stating, that, “under Obamacare, hardworking Americans saw their premiums skyrocket and their health care choices shrink, all while fraud benefitted insurance companies.”

Taking the pulse of health care fraud in the U.S.

In an interview with KFF Health News (3), Seto J. Bagdoyan, one of the GAO report’s authors, cautioned that the findings only focus on “indicators of potential fraud” rather than conclusive evidence. And the report itself offers some important context to the big numbers that made headlines.

For example, the full 26-page preliminary report (4) specifies that the 30,000 applications affected by “unauthorized changes” in 2023, and the 160,000 in 2024, represent only 0.4% and 1.5% of all applications in those respective years.

And as for the duplicate SSNs, the roughly 29,000 from 2023 account for only 0.21% of all SSNs that received subsidies that year. The 66,000 duplicate SSNs in 2024 only accounted for 0.37%. Beyond representing less than 1% of all SSNs inputted, the report notes that the duplicates could also be a result of “data entry errors” and that further investigation is required.

It really is trivial, the scope of fraud,” Lehigh University professor of health policy Michael Gusmano told CNBC about the report (5). “It’s just a scare tactic to justify the reduction of the federal government’s role in subsidizing health insurance.”



I don’t have a link , since it was a report in my email news digest but the link was to moneywise.com


Bold/italics mine

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