The Trump administration says it has uncovered a $10 billion fraud scheme within the Affordable Care Act, with officials alleging improper payments were made between 2021 and 2024 due to weakened enrollment safeguards.
A Department of Health and Human Services report obtained by Fox News Digital details the findings. The administration says nearly three million fraudulent or improper enrollments have already been removed from ACA exchanges, with an estimated 2.6 million additional questionable enrollments still under review.
What The Report Alleges
According to the report, several forms of abuse contributed to the alleged fraud. Some applicants allegedly understated their income to qualify for larger taxpayer-funded subsidies, while others received premium assistance despite not meeting eligibility requirements.
Federal 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. “By our estimate, improper, phantom, and fraudulent enrollment peaked at 5.6 million people in 2025,” the report states.
The report traces the alleged problems to changes made during the Biden administration that expanded enrollment opportunities while relaxing income verification and eligibility checks. ACA enrollment grew from approximately 10 million people at the start of Biden’s presidency to roughly 22 million by 2024.
Actions Taken
Since taking office, the Trump administration says it has restored stricter income verification requirements, ended several special enrollment periods and increased screening for duplicate Medicaid enrollment. The administration also launched investigations into brokers suspected of creating phantom policies and strengthened oversight of agents participating in the federal marketplace.
EXCLUSIVE: Some Americans were allegedly enrolled in Obamacare without ever knowing it.
The Trump administration says insurance brokers created "phantom enrollments" by signing people up without their knowledge, while others allegedly misstated their incomes or received… pic.twitter.com/FfhNhQ6vjl
— Fox News (@FoxNews) June 26, 2026
Nearly three million enrollments have been removed as a result of these efforts. Approximately 19.2 million people remain enrolled in ACA exchanges after the removals.
“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.
Broader Implications
The findings are likely to reignite debate over how aggressively eligibility rules for the Affordable Care Act should be enforced. Supporters of the administration argue the report demonstrates stricter oversight is necessary to protect taxpayers and preserve benefits for those legally entitled to receive them.
Critics have long warned that loosening enrollment safeguards could increase improper payments and fraud. Supporters of the Biden-era policies argued the changes made healthcare more accessible to eligible Americans.
The administration says investigations remain ongoing, with 2.6 million enrollments still under review as officials continue auditing the federal health insurance exchanges.
This story has been updated. CNN’s reporting team contributed to this report.
