FIRST ON FOX: The Trump administration is sending notices of intent to 100 agents affiliated with the Obamacare marketplace who allegedly violated the exchange’s standards of conduct by submitting insurance applications without recipients’ Social Security numbers or other identifying information.
The Centers for Medicare & Medicaid Services (CMS), led by Dr. Mehmet Oz, alleged that agents did this “repeatedly.”
A marketplace agent is a professional who helps people shop for healthcare through the Affordable Care Act (ACA) exchange.
More broadly, CMS estimates that “roughly 35% of Marketplace enrollments may be illegitimate.”
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If 35% of enrollments by agents are illegitimate, that represents about 5 to 6 million people “whose premiums could be improperly subsidized,” CMS said in a statement to Fox News Digital.
The action being taken against the 100 agents comes after a report published by the Health and Human Services Department found that “2.6 million improper or phantom enrollments remain, including more than 1 million enrollments submitted without a Social Security number.”
In response, the CMS has advanced a number of ACA reforms meant to protect taxpayers and patients from alleged fraud, waste and abuse.
The proposed reforms, the CMS said, would have saved $3 billion. The agency accused Democrats in Congress of preventing the full implementation of these provisions.
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The CMS’s latest action against ACA agents is another step in the agency’s crackdown on fraud.
Oz sent letters in May to Minnesota, California, Florida, New York and Maine about possible medical equipment fraud.
An anti-fraud task force, led by Vice President JD Vance, announced in February that durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers will be targeted through a nationwide moratorium.
That task force revealed new figures in early July that show a drastic 7,100% spike in Medicare claims for skin substitutes in just six years.
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The staggering increase in claims occurred between 2019 and 2025, surging from $200 million to $14.4 billion, prompting the anti-fraud task force and CMS to identify potentially fraudulent claims and deny 96% of claims made since March.
The CMS identified 4,200 suspicious claims for skin substitutes, known as allografts, totaling $224 million in charges through May of this year.
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