GAO Report Details Gaps in ACA Marketplace Fraud Prevention and Oversight

A recent U.S. Government Accountability Office (GAO) report highlights ongoing deficiencies in identifying and preventing fraud, waste, and abuse by agents and brokers within the Affordable Care Act (ACA) Marketplace. The report underscores a lack of effective enforcement and oversight mechanisms, resulting in persistent vulnerabilities to fraudulent activities in the ACA exchange system. Critically, the report points out that in May, the Trump administration reinstated 850 agents and brokers who were previously suspended under reasonable suspicion of fraud, raising concerns about regulatory enforcement rigor during that period. The GAO findings have spurred calls from lawmakers for intensified oversight and stricter regulatory compliance to safeguard taxpayer funds and stabilize ACA Marketplace premiums. These developments emphasize the continued challenges in maintaining integrity and transparency in ACA program administration, with implications for policy enforcement and risk management in health insurance markets.