CMS Cracks Down on Fraud, Waste, and Abuse in the Federal Health Insurance Marketplace®

CMS Cracks Down on Fraud, Waste, and Abuse in the Federal Health Insurance Marketplace ^®

As part of the ongoing efforts of the White House Task Force to Eliminate Fraud to crush fraud in the healthcare system and protect taxpayer dollars, the Centers for Medicare & Medicaid Services (CMS) is taking aggressive, sweeping actions within the Federal Marketplace - canceling approximately 315,000 unauthorized enrollments covering more than 760,000 individuals, which is expected to result in a return of roughly $2.2 billion in taxpayer-funded subsidies.

CMS has established a Federally-facilitated Exchange (FFE) anti-fraud coordination group that brings together leadership from across CMS and the U.S. Department of Health and Human Services (HHS) to drive a unified, sustained response to fraud in the Federal Marketplace. The group will meet regularly to coordinate enforcement and program integrity efforts and maintain momentum in the fight to crush fraud in the FFE.

"We are shutting down unauthorized Marketplace enrollments and returning approximately $2.2 billion in taxpayer-funded subsidies," said HHS Secretary Robert F. Kennedy, Jr. "CMS is strengthening safeguards, pursuing bad actors, and holding agents and brokers accountable when they break the rules. Under President Trump, HHS will protect Americans' health coverage and ensure taxpayer dollars reach the people they are intended to serve."

These actions are part of CMS' three-pronged strategy to prevent fraudulent and improper enrollments, remove existing unauthorized enrollments, and strengthen oversight and enforcement of agents and brokers participating in Exchanges.

"Every dollar lost to fraud is a dollar taken from hardworking taxpayers and the Americans these programs are intended to serve," said CMS Administrator Dr. Mehmet Oz. "We are using our data, enforcement authorities, and stronger safeguards to identify fraud and abuse, stop it, and recover taxpayer dollars. We are making sure Americans - not bad actors - remain in control of their health coverage."

CMS will continue working with health insurance companies to identify and investigate potentially unauthorized enrollments, cancel those confirmed to be unauthorized, and recoup and end associated taxpayer-funded subsidies.

The agency is also holding agents and brokers accountable for violating Marketplace standards. Since January 2026, CMS has issued termination notices for over 200 non-compliant agents and brokers. This summer, CMS issued 569 notices of intent to terminate to those agents and brokers who submitted 2026 applications without key applicant information, such as Social Security Numbers (SSN).

CMS data also show that agents and brokers who first registered for the 2026 plan year represent a small fraction of all agent- and broker-assisted enrollments but account for a disproportionate share of unauthorized enrollments and other high-risk activity in the Marketplace. To address this risk, CMS is releasing an Interim Final Rule announcing a temporary moratorium on new registration for the 2027 plan year for agents and brokers without an active Exchange Agreement for 2026.

CMS is also strengthening program integrity protections by:

• Requiring all existing agents and brokers to re-identity proof through Login.gov or ID.me;
• Requiring applications involving an agent or broker to include SSN or immigration document numbers that CMS can verify for all non-newborn applicants through all application channels;
• Updating the system to prevent agents and brokers from being added to applications that consumers should be completing on their own through HealthCare.gov; and
• Requiring electronic consumer authorization before an agent or broker can act on a consumer's application or enrollment.

Taken together, these measures strengthen Marketplace integrity, hold bad actors accountable, and better protect consumers and taxpayers from unauthorized activity.

For more information about Marketplace Anti-Fraud actions, visit: https://www.cms.gov/newsroom/fact-sheets/federal-marketplace-ffe-sbe-fp-anti-fraud-actions .

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