The Florida insurance brokers offered an enticing deal to unemployed and homeless people: Enroll in a Healthcare.gov health plan they weren’t eligible for in exchange for gift cards, food, alcohol or cash. They coached them to lie about their income to qualify for heavily subsidized coverage, according to court documents. Sometimes they enrolled people without their knowledge.
When the Government Accountability Office, which evaluates federal programs and spending, submitted 20 fraudulent applications to Healthcare.gov for coverage this year, 19 were initially approved even though the agency didn’t submit documents requested to prove income, citizenship and Social Security numbers. The marketplace terminated one enrollee for insufficient documentation. The government is still paying more than $10,000 a month in subsidies for 18 remaining enrollments.
Investigators also discovered misuse of Society Security numbers — in one case, a single number was used for 125 policies in 2023 — and identified serious shortcomings in how CMS assesses marketplace fraud.
Source: Washington Post
Stopping marketplace fraud is “not a priority” for CMS, said Seto Bagdoyan, a director at GAO who worked on the report.