Paragon Health Institute Reveals Extensive Fraud in ACA Enrollment

Uncovering the Depths of Fraud in the Affordable Care Act

The Paragon Health Institute, a prominent authority on health care research, has recently unveiled alarming data regarding the Affordable Care Act (ACA). Their extensive studies indicate that the ACA is plagued by systemic failures, including widespread fraud and improper enrollment. By documenting millions of erroneous and non-existent enrollees, Paragon's findings reveal troubling insights into the escalating health care costs and the bias against workers receiving employer-sponsored health insurance, compelling many small businesses to abandon providing coverage.

Brian Blase, president of Paragon, voiced significant concern over the ongoing issues: "The latest votes in the Senate demonstrate a bipartisan acknowledgment that the ACA has not fulfilled its fundamental promise of affordable health coverage. It is crucial to adhere to the principles against funneling additional taxpayer resources to large insurance corporations, as reiterated by President Trump."

In a recent hearing before the House Judiciary Committee on December 10, Brian Blase testified alongside representatives from the Government Accountability Office (GAO). The GAO released new reports confirming that approximately 96% of fraudulent applications for subsidized health coverage were approved by the exchanges. Furthermore, a staggering $21 billion allocated as subsidies in 2023 remains unaccounted for, and concerningly, various enrollees have been linked to Social Security numbers that were incorrectly enrolled for over 366 days in 2024.

The Congressional Budget Office (CBO) corroborated these findings, estimating that out of the exchanges, approximately 2.3 million enrollers were ineligible. This number primarily reflects those who incorrectly estimated their income in ten states that opted not to expand their Medicaid programs under the ACA.

In June 2024, Paragon commenced its investigations into the motivations driving fraudulent practices by insurers, agents, brokers, and enrollees. Alarmingly, there were 5 million ineligible enrollees in fully subsidized plans over the prior year. This issue intensified under President Biden’s administration, with the subsequent year recording 6.4 million improperly enrolled individuals and improper spending soaring to $27 billion.

Adding to the alarming statistics, data from the Centers for Medicare and Medicaid Services indicated a significant increase in exchange enrollees who never utilized their health plans—a raising from 35% in 2024 to 40% amongst those with full subsidies, a figure that has doubled since the introduction of COVID-related assistance.

Insurers received an astonishing $35 billion in 2024 for exchange participants who failed to utilize their coverage. Reports from federal oversight bodies and investigative journalists have increasingly documented large instances of fraud, waste, and abuse across various government health programs. Numerous shocking accounts of fraud have emerged from states such as Minnesota, Florida, and Maine, echoing concerns previously articulated by Paragon analyses.

In light of these findings, there is a pressing need for comprehensive reforms and increased scrutiny over the ACA to protect eligible enrollees and safeguard taxpayer money from falling prey to fraudulent activities. The focus is now turning towards actionable solutions to address these vulnerabilities within the healthcare system as Paragon pushes for heightened accountability and integrity in health insurance management.

For more information on Paragon Health Institute's findings and continued research efforts, visit paragoninstitute.org.

About Paragon Health Institute

Founded in late 2021 by Brian Blase, the Paragon Health Institute is a 501(c)(3) non-profit organization dedicated to health policy research and market-driven policy solutions aimed at improving outcomes in both public and private sectors. Importantly, Paragon does not accept funding from industry sources and avoids any lobbying efforts, focusing solely on the integrity of health policy analysis and advocacy.

For media inquiries, please contact Anthony Wojtkowiak at 703-527-2734 or via email at [email protected]