Trump Administration Notifies 100 ACA Marketplace Agents of Suspected Conduct Violations
Key Takeaways
- •The Trump administration is issuing notices of intent to 100 ACA marketplace agents who allegedly submitted insurance applications without required identifying information such as Social Security numbers.
- •CMS estimates that approximately 35% of marketplace enrollments may be illegitimate, potentially resulting in 5 to 6 million people receiving improperly subsidized premiums.
- •A Department of Health and Human Services report identified 2.6 million improper or phantom enrollments, including more than 1 million submitted without a Social Security number.
- •CMS stated that proposed ACA reforms would have saved $3 billion, but Democrats in Congress blocked their full implementation.
- •An anti-fraud task force led by Vice President JD Vance reported a 7,100% spike in Medicare skin substitute claims between 2019 and 2025, prompting CMS to deny 96% of claims submitted since March.
The Trump administration is issuing notices of intent to 100 agents affiliated with the Affordable Care Act (ACA) marketplace, alleging they violated the exchange's standards of conduct by repeatedly submitting insurance applications without recipients' Social Security numbers or other identifying information.
The Centers for Medicare & Medicaid Services (CMS), under the leadership of Dr. Mehmet Oz, announced the action. CMS stated that the agents engaged in the practice "repeatedly." The notices represent a preliminary step that could lead to suspension or termination of the agents' ability to operate on the federal exchange, a channel through which tens of millions of Americans obtain subsidized health coverage.
A marketplace agent is a professional who assists individuals in shopping for healthcare coverage through the ACA exchange. CMS estimates that "roughly 35% of Marketplace enrollments may be illegitimate." If that proportion of agent-submitted enrollments is indeed illegitimate, it would represent approximately 5 to 6 million people "whose premiums could be improperly subsidized," CMS said in a statement to Fox News Digital.
The notices to the 100 agents follow a report from the Department of Health and Human Services that found "2.6 million improper or phantom enrollments remain, including more than 1 million enrollments submitted without a Social Security number." The scale of the issue underscores long-standing concerns about program integrity on the ACA exchange, which has seen record enrollment growth in recent years.
In response, CMS has advanced a series of ACA reforms designed to protect taxpayers and patients from alleged fraud, waste, and abuse. According to the agency, the proposed reforms would have saved $3 billion, but Democrats in Congress prevented the full implementation of these provisions.
The enforcement action marks the latest step in CMS's broader crackdown on healthcare fraud. In May, Oz sent letters to Minnesota, California, Florida, New York, and Maine flagging possible medical equipment fraud.
An anti-fraud task force led by Vice President JD Vance announced in February that suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) would be targeted through a nationwide moratorium.
In early July, that same task force disclosed new figures revealing a 7,100% spike in Medicare claims for skin substitutes over a six-year period. The increase occurred between 2019 and 2025, with claims surging from $200 million to $14.4 billion. In response, the task force and CMS moved to identify potentially fraudulent claims and denied 96% of claims submitted since March.
CMS identified 4,200 suspicious claims for skin substitutes, known as allografts, totaling $224 million in charges through May of this year.