GOP targets major brokers in Obamacare enrollment fraud investigation
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Republicans in the House want to know whether some of the nation’s largest Obamacare health insurance brokers are contributing to the dismal picture of fraud that has led to the program’s rising costs.
The House Judiciary Committee, led by Chairman Jim Jordan, R-Ohio, heard Monday that Blue Shield of California, Centene Corporation, CVS Health, Elevance Health, Kaiser Permanente, Oscar Health Inc. and sent letters to GuideWell requesting detailed information about its registration services.
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Representative Jim Jordan leaves a House Republican Conference meeting at the U.S. Capitol in Washington on December 10, 2024. (Tom Williams/CQ-Roll Call, Inc. via Getty Images)
All of these companies help consumers sign up for Obamacare’s increased health insurance premiums, which are at the center of the committee’s fraud assessments.
“Brokers targeted individuals with deceptive advertising and pressured enrollees to lie about their income to receive Obamacare subsidies. Evidence shows that many people did not even know they were enrolled in health insurance or agreed to switch plans,” the committee said in a statement. he said.
The committee asked companies to provide a list of how many people they helped enroll in enhanced premium tax credits, the number of enrollees who did not receive those benefits, internal communications combating fraud and abuse, and employees involved in fraud prevention efforts.
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House Judiciary Chairman Jim Jordan, R-Ohio, listens during a hearing before the House Judiciary Subcommittee on July 20, 2023 in Washington. (Anna Moneymaker/Getty Images)
The justice’s letters come as lawmakers grapple with whether to extend Obamacare’s increased premium subsidies (as questions remain about fraud and other inefficiencies) or let them expire at the end of the year.
Congress initially greatly expanded Obamacare federal aid in 2021 as an emergency response to COVID-19. More than 90% of the 24 million people enrolled in Obamacare now receive expanded benefits, accordingly Research by the Kaiser Family Foundation.
Seto Bagdoyan, GAO’s director of audit services, told Fox News Digital that under the current expanded framework, brokers are encouraged to enroll as many people as possible. He helped write a recent GAO report detailing how Obamacare administrators had a poor understanding of where federal aid dollars would end up.
Bagdoyan said, “So the incentive system for brokers is commission-based. They receive commission from the subsidies paid to insurance companies.” he said.
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Seto Bagdoyan, Director of the Government Accountability Office’s Audit Services, Forensic Audits and Investigative Service, testified before the House Ways and Means Oversight Subcommittee in Washington on July 23, 2014. (Win McNamee/Getty Images)
According to the GAO, some 29,000 Social Security numbers (SSNs) in 2023 and nearly 68,000 SSNs in 2024 were receiving more than a year of coverage with APTC in a single plan year.
Bagdoyan explained that the extent of the fraud and the role brokers play in this picture is not fully understood, but he believes it contributes to the exorbitant costs of the program.
“The unscrupulous ones will probably go on the field and raise the score, as we think we encountered in our analysis. [Fraud examples] It includes not only changes to the registered agent or broker, but also changes to policies, new policies, and outright fraud policies. This is part of the broken side,” Bagdoyan said.
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The Judiciary Committee requested responses from letter recipients no later than December 29.
Fox News Digital has reached out to the buyers for comment.
