CMS warns 100 ACA marketplace agents of alleged enrollment violations

The Centers for Medicare & Medicaid Services has sent letters of intent to 100 marketplace agents accused of repeatedly filing ACA applications without required Social Security numbers or other identifiers. Mehmet Oz, head of CMS, warned that roughly 35% of enrollments may be illegitimate, representing 5-6 million individuals whose subsidies could be improperly paid. The move follows a Health and Human Services Department report that uncovered 2.6 million improper or phantom enrollments, including more than one million lacking Social Security numbers.

CMS says its proposed anti-fraud reforms would have saved $3 billion, but claims they have been stalled by Democrats in Congress. The agency also cited recent anti-fraud efforts targeting medical-equipment suppliers, noting a 7,100% rise in Medicare skin-substitute claims from 2019 to 2025 and a denial rate of 96% on recent claims. These steps are part of a broader crackdown on alleged fraud, waste, and abuse within the ACA system.