The Trump administration says it has identified a $10 billion fraud scheme within the Affordable Care Act, alleging improper payments occurred between 2021 and 2024 due to relaxed enrollment safeguards.
A Department of Health and Human Services report details findings that officials attribute to changes made during the Biden administration that expanded enrollment while reducing income verification and eligibility checks. The administration says it has already removed nearly three million fraudulent or improper enrollments and estimates 2.6 million questionable enrollments remain in the system.
What the Report Found
Federal investigators identified multiple forms of alleged abuse contributing to improper enrollments. Some applicants intentionally understated income to qualify for larger taxpayer-funded subsidies, while others received premium assistance despite failing to meet eligibility requirements, according to the report.
Officials also identified “phantom enrollments,” in which insurance brokers allegedly enrolled individuals in Obamacare plans without their knowledge to collect federal commissions. “By our estimate, improper, phantom, and fraudulent enrollment peaked at 5.6 million people in 2025,” the report states. “We estimate 2.6 million improper and phantom enrollments remain, including over 1 million enrollments without a Social Security number.”
Obamacare enrollment surged from approximately 10 million people at the start of Biden’s presidency to roughly 22 million by 2024. Federal investigators now believe millions of those enrollments were improper, fraudulent, or created without individuals’ knowledge.
Trump Administration Actions
Since taking office, the administration says it has restored stricter income verification requirements, ended several special enrollment periods, and increased screening for duplicate Medicaid enrollment. Officials also strengthened oversight of agents participating in the federal marketplace and launched investigations into brokers suspected of creating phantom policies.
Nearly three million enrollments have been removed from the Affordable Care Act exchanges as a result. Approximately 19.2 million people remain enrolled following those removals. The administration says its goal is to ensure taxpayer dollars are spent only on individuals who qualify for coverage.
“Preserving the fiscal and programmatic integrity of the ACA Exchanges is key to safeguarding taxpayer-funded resources for those that truly need them,” the report states. “The federal government paying brokers to enroll individuals without their knowledge is not.”
The Ongoing Debate
The findings are likely to reignite debate over how aggressively the Affordable Care Act’s eligibility rules should be enforced. Supporters of the administration argue the report demonstrates that stricter oversight is necessary to protect taxpayers and preserve benefits for those legally entitled to them.
Critics of previous verification rollbacks have long warned that loosening enrollment safeguards could increase improper payments and fraud. Supporters of Biden-era policies contended the changes made healthcare more accessible to eligible Americans.
The administration says investigations remain ongoing, with an estimated 2.6 million additional enrollments still under review as officials continue auditing the federal health insurance exchanges.