The Trump administration is sending notices of intent to 100 agents affiliated with the Affordable Care Act marketplace who allegedly violated the exchange’s standards of conduct by submitting insurance applications without recipients’ Social Security numbers or other identifying information, according to a report published Thursday by Fox Business.
The Centers for Medicare & Medicaid Services (CMS), led by Administrator Dr. Mehmet Oz, alleged the agents did this “repeatedly.”
Marketplace agents are licensed professionals who help consumers enroll in health insurance through the Affordable Care Act, commonly known as Obamacare. More broadly, CMS estimates that “roughly 35% of Marketplace enrollments may be illegitimate.” If that estimate is accurate, it represents about 5 million to 6 million people “whose premiums could be improperly subsidized,” CMS said in a statement to Fox News Digital.
HHS report fuels enforcement effort
The latest action comes after a Department of Health and Human Services report found that “2.6 million improper or phantom enrollments remain, including more than 1 million enrollments submitted without a Social Security number,” according to the report. In response, CMS has advanced several Affordable Care Act reforms intended to reduce fraud, waste and abuse. The agency said the proposed reforms would have saved about $3 billion and accused Democrats in Congress of preventing their full implementation.
CMS did not immediately respond to Benzinga’s request for comment.
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Part of broader healthcare fraud push
The latest enforcement effort adds to the Trump administration’s broader campaign against fraud across federal healthcare programs. In April, Oz directed all 50 states to submit Medicaid provider revalidation plans within 30 days or face intensified federal audits, saying, “We’re asking the states to own that problem red and blue, all of them. If you don’t take it seriously, it indicates to us that we might have to take the audits more aggressively.”
The administration has also expanded enforcement through Vice President JD Vance‘s anti-fraud task force. In May, Vance announced a six-month pause on certain Medicare enrollments and a $1.3 billion Medicaid funding deferral tied to California while warning states that fail to address Medicaid fraud could face additional funding consequences.
Fox Business reported that the task force has continued widening its focus. In February, it announced a nationwide moratorium targeting suppliers of durable medical equipment, prosthetics, orthotics and supplies. Earlier this month, the task force said Medicare claims for skin substitutes increased from about $200 million in 2019 to $14.4 billion in 2025, a roughly 7,100% jump. The increase prompted CMS to identify potentially fraudulent claims and deny 96% of claims submitted since March. The agency also identified about 4,200 suspicious claims for skin substitutes, known as allografts, totaling $224 million in charges through May.
The broader healthcare fraud crackdown has also extended to criminal enforcement. In May, a federal jury convicted HealthSplash founder and CEO Brett Blackman in what the Department of Justice described as a more than $1 billion Medicare fraud scheme involving fraudulent telemedicine prescriptions and medically unnecessary medical equipment. Prosecutors alleged the conspiracy generated more than $1 billion in false Medicare claims and more than $450 million in payments from federal healthcare programs.
Disclaimer: This content was produced with the help of AI tools and was reviewed and published by Benzinga editors.
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