Rep. Doggett Demands Answers on Trump Failure to Address ACA Broker Fraud

Washington, D.C.-Today, U.S. Representative Lloyd Doggett (TX-37), Ranking Member of the Ways and Means Health Subcommittee, sought answers from Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Oz concerning CMS's response to agent and broker fraud in the Affordable Care Act Marketplace. His action follows alarming findings in a new, nonpartisan U.S. Government Accountability Office (GAO) report revealing persistent failure by the Trump Administration to identify and prevent fraud.

"GAO has revealed Trump's permissive response to extensive fraud caused by insurance broker/agent wrongdoing. The remedy is not to deny a mother access to care for her sick child. What we need is effective law enforcement and less Trump coddling and pardoning of offenders ," said Rep. Doggett. "Yelling "fraud" while empowering criminals solves nothing and will harm many. As usual, House Republicans fear any meaningful oversight of the Trump regime."

Rep. Doggett's full letter can be found hereand below.

Dear Administrator Oz:

I write regarding CMS's response to the deeply alarming findings in the Government Accountability Office's recent report concerning persistent unauthorized and fraudulent enrollments and plan switches in the federally-facilitated Marketplace completed by agents and brokers without consumer consent.

GAO's preliminary analysis identified "30,000 applications in plan year 2023 and at least 160,000 applications in plan year 2024 that had likely unauthorized changes."^[1]CMS records also show nearly 275,000 related complaints from January-August 2024.^[2]

Between June and October 2024, CMS suspended 850 agents and brokers for suspected fraudulent or abusive conduct related to unauthorized enrollments or plan switches.^[3] Although initially prohibited from participating in the Marketplace, CMS officials confirmed to GAO in May 2025 that CMS reinstated all of these suspended agents.^[4]No meaningful justification was offered for reinstatement, nor was any explanation provided as to what investigatory steps were taken to assure no criminal activity had occurred.

I am further concerned that CMS has diminished its oversight and enforcement capacity with the apparent layoff of 200 staff members in the Office of Program Operations and Local Engagement, which oversees Marketplace fraud.^[5]I am deeply alarmed that such reductions may impair CMS's ability to maintain proper oversight, ensure timely relief for victims, and hold these fraudulent actors accountable.

GAO also outlines serious and longstanding failures in CMS's fraud risk management. Despite major program changes, CMS has not updated its fraud risk assessment and failed to properly identify all inherent fraud risks, including those specific to state-based Marketplaces. GAO further found CMS failed to meaningfully evaluate whether its existing controls were effective and, in some cases, may have overstated their impact. CMS did not develop a formal antifraud strategy aligned with leading practices in GAO's Fraud Risk Framework. Such failures hinder CMS's ability to proactively identify and mitigate fraud risks.^[7]Given these failures, I urge CMS to use the full extent of its enforcement authority, including imposing civil monetary penalties under Section 1411(h) of the Affordable Care Act.

To better understand CMS's response to fraud in the ACA Marketplace, I request your prompt response to the following questions by no later than December 19, 2025:

1. For the 850 brokers suspended between June and October 2024 who were reinstated by the Trump Administration, what investigatory steps were conducted to assure no criminal activity or other wrongdoing occurred? For each individual, please include case descriptions concerning the reason for suspension; accompanying evidence, including whether the individual had any previous suspension or other enforcement action; and the basis for your reinstatement of each. Please provide any reinstatement notice issued to brokers and agents, as well as any notice provided to the respective state insurance commissioner.
2. Separately, please identify what specific oversight and safeguards have been used to ensure no repeat offenses by these reinstated individuals, and indicate whether any have been a subject of new complaints.
3. What steps has CMS taken this year to detect and dismantle fraud schemes by agents, brokers, or other actors engaging in unauthorized enrollments or plan switches? Please include all relevant policies, guidance, and implementation dates.
4. Since implementation of the federally-facilitated Marketplace, how many civil monetary penalties or similar enforcement actions have been issued against agents and brokers? Please detail each individual case, including the circumstances resulting in the enforcement action, the timeline, and what specific enforcement actions were taken. Please also identify any cases referred for prosecution.
5. Did state insurance commissioners identify any of the suspected fraudulent conduct that resulted in the suspension of agents and brokers? Did the commissioners offer any evidence that resulted in the suspensions, or the later reinstatement decisions?
6. What is CMS's plan and timeline for updating and developing its antifraud strategy related to Advanced Premium Tax Credits?
7. As of October 2024, CMS reported that most unauthorized enrollment cases were being resolved within approximately 52 days of receipt, with unauthorized plan switches being resolved within approximately 16 days.^[8]What is CMS's current average timeline to resolve consumer complaints concerning unauthorized enrollments or plan changes? Please provide the average timeline for calendar years 2023, 2024, and 2025.
8. How many staff members in HHS's Office of Program Operations and Local Engagement received layoffs or took early retirement this year? Have any of these staff members been reinstated? Please provide the number of staff members and timeline for layoffs, and if relevant, reinstatement.
9. Under Title XXVII of the Public Health Service Act, CMS has authority to take enforcement action against insurance issuers to ensure compliance with health insurance market reforms, where the state lacks statutory authority or is not enforcing such provisions. Given this authority, what consequences, if any, do insurance agencies face when their agents are suspected or found guilty of unauthorized or fraudulent Marketplace activity? Please provide all relevant enforcement records.

Thank you for your timely attention to this matter.

Cc: Secretary, Department of Health and Human Services

Peter Nelson, Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight