The Trump administration says it has uncovered what it describes as a massive fraud scheme within the Affordable Care Act.
Members of Trump’s administration allege that roughly $10 billion in taxpayer money was improperly paid out between 2021 and 2024 because of weakened enrollment safeguards under former President Joe Biden.
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According to a Department of Health and Human Services report, officials have already removed nearly three million fraudulent or improper Obamacare enrollments and estimate another 2.6 million questionable enrollments remain.
Administration officials say the findings are part of a broader government-wide effort to eliminate fraud, waste, and abuse across federal programs.
The report traces the alleged problems to changes made during the Biden administration that expanded enrollment opportunities while relaxing income verification and eligibility checks.
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At the start of Biden’s presidency, the Affordable Care Act exchanges enrolled approximately 10 million people. By 2024, enrollment had surged to roughly 22 million.
Federal investigators now believe millions of those enrollments were improper, fraudulent, or created without the knowledge of the individuals involved.
“By our estimate, improper, phantom, and fraudulent enrollment peaked at 5.6 million people in 2025,” the report states.
“We estimate 2.6 million improper and phantom enrollments remain, including over 1 million enrollments without a Social Security number.”
According to the report, several different forms of abuse contributed to the alleged fraud.
Officials say some applicants intentionally understated their income to qualify for larger taxpayer-funded subsidies.
Others allegedly received premium assistance despite failing to meet eligibility requirements.
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Investigators also identified what they describe as “phantom enrollments,” in which insurance brokers allegedly enrolled people in Obamacare plans without their knowledge to collect federal commissions.
The report argues that reduced verification requirements made those practices significantly easier to carry out.
Since taking office, the Trump administration says it has restored stricter income verification requirements, ended several special enrollment periods, increased screening for duplicate Medicaid enrollment, and launched investigations into brokers suspected of creating phantom policies.
Officials also say they have strengthened oversight of agents participating in the federal marketplace.
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As a result of those efforts, the Affordable Care Act exchanges have already removed nearly three million enrollments.
Even after those removals, approximately 19.2 million people still have coverage.
The administration says its goal is not to reduce legitimate coverage but to ensure that taxpayer dollars go only to individuals who actually qualify.
“Preserving the fiscal and programmatic integrity of the ACA Exchanges is key to safeguarding taxpayer-funded resources for those that truly need them,” the report states.
“The federal government paying brokers to enroll individuals without their knowledge is not.”
The report also says the administration will continue pursuing additional enforcement actions against brokers and others accused of exploiting the program.
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“The Trump Administration continues to aggressively root out fraud, waste, abuse, and corruption by promulgating new regulations to improve program integrity, investigating suspected improper or fraudulent enrollment, and taking action against agents and brokers committing fraud.”
The findings are likely to reignite debate over the Affordable Care Act and how aggressively eligibility rules should be enforced.
Supporters of the administration argue the report demonstrates that stricter oversight is necessary to protect taxpayers and preserve benefits for those legally entitled to receive them.
Critics of previous verification rollbacks have long warned that loosening enrollment safeguards could increase improper payments and fraud, while supporters of the Biden-era policies argued the changes made healthcare more accessible to eligible Americans, Fox News reported exclusively.
The administration says its investigations remain ongoing, with an estimated 2.6 million additional enrollments still under review as officials continue auditing the federal health insurance exchanges.
Trump has been pushing to replace Obamacare for over a decade, and this may give Republicans enough motivation to actually do something.
This article may contain commentary which reflects the author’s opinion.
