Watchdog Uncovers Massive Fraud, Waste in Obamacare Insurance Tax Credits
For plan year 2024, GAO identified almost 66,000 SSNs that had more than 366 days of coverage.
An analysis of the Patient Protection and Affordable Care Act (PPACA), commonly known as Obamacare, has unveiled massive fraud that could be costing American taxpayers billions of dollars, the Government Accountability Office (GAO) said in a report released on Dec. 3.
Under the program, the federal government pays credits to health insurance companies, called advance premium tax credit (APTC), on behalf of eligible Obamacare participants to reduce their monthly premium payments. In plan year 2024, almost $124 billion in such credits is estimated to have been paid out to insurance companies, accounting for around 19.5 million enrollees.

The GAO report identified instances of social security number (SSN) abuse involving identity theft and similar fraudulent practices.

GAO’s analysis identified more than 29,000 SSNs that had insurance coverage with APTC for more than 365 days in plan year 2023, suggesting that these social security numbers could be used by multiple Obamacare enrollees.

“The most frequently used SSN in plan year 2023 was used to receive subsidized insurance coverage for over 26,000 days (over 71 years of coverage) across over 125 insurance policies,” the report said.

For plan year 2024, GAO identified almost 66,000 SSNs that had more than 366 days of coverage.

https://www.theepochtimes.com/...ws&test_user_group=b

Is anyone surprised?

Nope.

I don't subscribe to the Epoch Times... but here's more:

Federal Watchdog Reveals Rampant Obamacare Fraud; 90% Of Bad-Doc Applicants Approved In Undercover Test

A new bombshell report from the Government Accountability Office (GAO) details a long-running vulnerability in the Affordable Care Act exchanges, showing that weak verification controls continue to expose federal subsidies to significant fraud and abuse.

“Preliminary results from GAO's ongoing covert testing suggest fraud risks in the advance premium tax credit (APTC) persist,” the report reads. “The federal Marketplace approved coverage for nearly all of GAO's fictitious applicants in plan years 2024 and 2025, generally consistent with similar GAO testing in plan years 2014 through 2016.”

According to the report, GAO conducted undercover tests by creating fictitious applicants with fake identities and fraudulent or never-issued Social Security numbers to see how the federal Marketplace would respond. Over the past two years, 90% of those fake applicants were approved for subsidized coverage despite lacking required documentation. In plan year 2024, all four of GAO’s fabricated applicants were approved and received about $2,350 per month in subsidies paid to insurers, even though they failed to provide proof of Social Security numbers, citizenship, or income. GAO scaled up the test for 2025 to 20 fake applicants; 18 were still enrolled as of September 2025, generating more than $10,000 per month in subsidies

More broadly, GAO's preliminary analyses identified vulnerabilities related to potential SSN misuse and likely unauthorized enrollment changes in federal Marketplace data for plan years 2023 and 2024. Such issues can contribute to APTC that is not reconciled through enrollees' tax filings to determine the amount of premium tax credit for which enrollees were ultimately eligible. GAO's preliminary analysis of data from tax year 2023 could not identify evidence of reconciliation for over $21 billion in APTC for enrollees who provided SSNs to the federal Marketplace for plan year 2023. Unreconciled APTC may not necessarily represent overpayments, as enrollees who did not reconcile may have been eligible for the subsidy. However, it may include overpayments for enrollees who were not eligible for APTC.

A big problem with reconciling these Obamacare subsidies is when someone uses a Social Security number that doesn’t actually belong to the person getting the insurance. GAO’s early look at federal Marketplace data found more than 29,000 Social Security numbers in 2023 that showed over a full year of subsidized coverage. One number was used so many times that it totaled more than 26,000 days of insurance across more than 125 plans - the equivalent of more than 71 years of coverage tied to a single number.

The pattern continued in 2024, with nearly 66,000 Social Security numbers being linked to more than a year of subsidized coverage. This can result from identity theft, fake identities, or simple typing errors. According to the GAO, determining the true owner of a Social Security number can be complicated, so it’s examining these cases and other examples of overlapping coverage more closely.

CMS officials say the federal Marketplace lets people sign up even when a Social Security number is already in use. They claim this helps the real owner of the number get coverage in cases of identity theft or simple typing mistakes. The system uses a model that analyzes various pieces of personal information to distinguish applicants, and CMS runs this check monthly to clear out duplicate accounts. They also say applications with repeated Social Security numbers are supposed to go through a data-matching process in which people send in documents to verify their identities. However, even with those explanations, the setup makes it far too easy for fake applicants to slip through, and clearly, they do. The way the system works gives fraudsters plenty of room to abuse Social Security numbers long before anyone notices.

GAO notes that its “covert testing is illustrative and cannot be generalized to the enrollee population.”

This report lands in the middle of an active policy fight on Capitol Hill over whether to extend enhanced Obamacare subsidies, giving Republicans fresh evidence for their arguments about the program’s structural problem, validating their long-standing criticisms of Obamacare. House Ways and Means Chair Jason Smith (R-Mo.) called the report a “smoking gun” showing how a flawed system, protected by Democrat policies, has pushed tens of billions of taxpayer dollars to insurers through identity fraud.

Energy and Commerce Chair Brett Guthrie (R-KY) argued that Democrats’ temporary expansion of subsidies worsened fraud, harmed patients, and hid deeper affordability problems. “Republicans have sounded the alarm on the flawed structural integrity of Obamacare and how Democrats’ failed policies to temporarily prop up the program have exacerbated fraud, hurt patients, increased the burden on American taxpayers, and artificially masked the true health care affordability crisis plaguing Americans today ,” Guthrie said. “The concerning findings from GAO’s report further confirm that Republican efforts to strengthen, secure, and sustain our federal health programs are critical and necessary to ensure access to quality health care at prices Americans can afford.”

https://www.zerohedge.com/poli...-applicants-approved

Delete Obamacare
By James T. Moodey

Government-run insurance never works, because the government does not invest premiums. Private-sector insurance companies invest premiums in high-quality commercial or industrial real estate, which typically grows about 8 percent per year in value, plus it earns rental income. Actuaries manage the process so there is enough to pay claims.

My wife and I were victims of the individual mandate on January 1, 2014. I use our example because I know the numbers, and it is an example of what happened to your employer.

Our Blue Cross agent emailed in early November 2013 to say that our existing policy would be canceled and we must choose an Obamacare policy by December 31. Our Blue Cross policies were major medical with a $5,000 deductible, costing $403 per month. My policy was $180 per month, and hers was $223 per month.

I asked our agent to quote an identical Obamacare policy — major medical with a $5,000 deductible. The quote came in at $1,092 per month. That is a 271-percent price increase.

She explained that most of the increase was because Obamacare eliminated the insurance company lookback, which required premium payments for a period of time prior to a claim. In other words, it allowed cheaters who could wait until they were diagnosed with cancer, then demand a policy. In that event, insurance companies collected no premiums to invest prior to their obligation to pay for cancer treatment.

She said that a lesser reason for the increase was that Obamacare does not allow discrimination against women; therefore, all policies had to be identical. So my policy rate went up to match my wife’s. The agent jokingly said that I qualified for up to $1,000 for a breast pump.

If we want to help the poor, leave the increased age threshold for Medicaid, but do not more than double the price of insurance for everyone else.

https://www.americanthinker.co...elete_obamacare.html

The Republicans have to show some spine and eliminate Obamacare. They've been all talk and no action since it was passed on Christmas Eve 2009. It was never designed to work. It has made a basic health insurance policy unaffordable, if not unobtainable.

This has been a growing problem, IMO the biggest problem we are currently facing. The group hardest hit are those ages 50+ who are too young for Medicare but don't have employer provided coverage.

Obamacare was designed to force universal healthcare, aka government socialized medicine. The push from the left is being called "Medicare For All" which is socialized medicine.

We need to be vigilant that the Republicans in DC don't buy into Medicare For All.

The federal government has no trouble connecting ssn to tax returns when they want to collect more money, such as with Medicare premiums. It should be simple to also connect it to when they make payments.

They did, within one week, terminate my sister's social security disability when she died.

My thesis is that the DC swamp designed Obamacare to make fraud easy, so that illegals and others could claim benefits they weren't entitled to. Thus creating more people dependent on DC.

quote:

Originally posted by Fly-Sig:
Obamacare was designed to force universal healthcare, aka government socialized medicine. The push from the left is being called "Medicare For All" which is socialized medicine.

Yes.

quote:

My thesis is that the DC swamp designed Obamacare to make fraud easy, so that illegals and others could claim benefits they weren't entitled to. Thus creating more people dependent on DC.

Yes.

Those of us who don't want a subsidized Obamacare policy are just going without any insurance at all. It's just not worth the price. And there's no incentive to pay it. If you get sick, get a policy then since they don't do underwriting anymore. They've just destroyed the concept of insurance which is a small certain risk (the premium) in exchange for a larger uncertain risk (a major medical problem).

Don't subsidize Obamacare; Delete Obamacare completely.

quote:

Originally posted by chellim1:
The Republicans have to show some spine and eliminate Obamacare. They've been all talk and no action since it was passed on Christmas Eve 2009. It was never designed to work. It has made a basic health insurance policy unaffordable, if not unobtainable.

This has been a growing problem, IMO the biggest problem we are currently facing. The group hardest hit are those ages 50+ who are too young for Medicare but don't have employer provided coverage.

The Republicans had an opportunity to get rid of Obamacare during Trumps first term but opted not to to try and embarrass Trump. There are a lot of republicans that aren't any better than democrats but if Obamacare is to go away now is the time to get rid of it.

Am I the only one who thinks that if these fraudsters were to put in as much time and effort into honest work that they wouldn't need Government-assisted health care?

^^^ Well, yeah, but if we got rid of Government-assisted health care (and other freebies from the taxpayer) they might have to work.
Which came first, the chicken or the egg? the subsidy or the lack of initiative?

Half of the Obamacare medical facilities don’t even have a physician. (“Provider”) You’re lucky if they have a PA, much less a Nurse Practitioner. First year of ACA when I was unemployed they were trying to assign “Mi Doctor” ghetto clinic as my primary care provider. No physician. To a woman in her 50s who had cancer less than a year before…

quote:

Originally posted by Fly-Sig:
Obamacare was designed to force universal healthcare, aka government socialized medicine. The push from the left is being called "Medicare For All" which is socialized medicine.

We need to be vigilant that the Republicans in DC don't buy into Medicare For All.

The federal government has no trouble connecting ssn to tax returns when they want to collect more money, such as with Medicare premiums. It should be simple to also connect it to when they make payments.

They did, within one week, terminate my sister's social security disability when she died.

My thesis is that the DC swamp designed Obamacare to make fraud easy, so that illegals and others could claim benefits they weren't entitled to. Thus creating more people dependent on DC.

As a medical practitioner myself, I am convinced Obamacare was designed to collapse and fail miserably, leading to a call for the government to enact a more socialist program/ agenda.
The entire insurance boondoggle Obamacare or not is a mess for patients, providers, hospitals and everyone involved except the insurance companies which continue to post record profits.

quote:

Originally posted by chellim1:
The Republicans have to show some spine and eliminate Obamacare. They've been all talk and no action since it was passed on Christmas Eve 2009. It was never designed to work. It has made a basic health insurance policy unaffordable, if not unobtainable.

This has been a growing problem, IMO the biggest problem we are currently facing. The group hardest hit are those ages 50+ who are too young for Medicare but don't have employer provided coverage.