The Government Accountability Office (GAO) said the Centers for Medicare & Medicaid Services (CMS), which oversees the federal Affordable Care Act exchange, lacked sufficient protections against unauthorized activity by agents and brokers. The findings come as officials continue efforts to address health care fraud and strengthen oversight of marketplace programs.
According to the GAO, complaints related to unauthorized enrollments and plan changes rose from a combined 66,548 cases in 2023 to 299,604 cases in 2025. The watchdog said some consumers only discovered changes to their coverage when they needed medical care or received tax-related notices.
The report focused on how agents and brokers interact with exchange accounts. It found that existing systems did not always verify consumer consent, limit account access to the broker connected with a consumer’s enrollment, or notify consumers about actions taken on their behalf.
GAO Identifies Weaknesses in Marketplace Account Protections
The GAO report found several weaknesses in the federal exchange’s security measures. The watchdog said CMS did not have enough safeguards to confirm that consumers approved actions taken by agents and brokers.
According to the report, some agents and brokers changed consumers into different Obamacare plans without their knowledge or consent. These changes could result in consumers needing to switch doctors, losing access to certain medications, or facing higher out-of-pocket costs.
The GAO recommended several measures to improve consumer protection. These included using one-time passcodes to verify authorization, limiting account access to the broker of record, and notifying consumers when brokers take actions on their exchange accounts.
The watchdog also warned that unauthorized changes involving incorrect income or eligibility information could create unexpected tax liabilities for consumers. The report noted that taxpayers could also be responsible for subsidies provided to people who were not eligible.
Consumers and Officials Raise Concerns over Unauthorized Activity
Many consumers affected by unauthorized marketplace changes do not find out about the issue immediately. The GAO reported that some people only became aware of changes after attempting to receive health care services or after receiving an Internal Revenue Service notice during tax season.
The report highlighted concerns that weak verification procedures could leave consumers unaware of decisions affecting their health coverage. The findings showed that account changes made without proper approval can create financial and medical disruptions.
CMS Administrator Dr. Mehmet Oz said in a statement to FOX Business that consumers should have confidence that their health coverage decisions are made by them and not by individuals attempting to exploit the system.
“CMS has made protecting Marketplace consumers a top priority, and we will continue strengthening our oversight, enforcement, and technology to prevent fraud, safeguard taxpayer dollars, and ensure consumers remain in control of their health coverage,” Oz said.
Fraud Enforcement Efforts Expand as Marketplace Concerns Grow
The report was released as the administration has increased its focus on health care fraud prevention. A 2024 CMS enrollment data review identified 2.8 million Americans who were potentially enrolled in multiple Medicaid, Children’s Health Insurance Program, or subsidized Affordable Care Act exchange plans.
The administration has also targeted Medicaid fraud, asking all 50 states to identify improper enrollment activity and create fraud prevention plans.
House Ways and Means Committee Chair Jason Smith, R-Mo., said the GAO findings showed major weaknesses in the system’s safeguards. He argued that consumers were sometimes enrolled in coverage they did not request and were not always informed about those changes.
According to Smith, Republicans are working to close loopholes, expand access to health care, reduce costs for working families, and protect taxpayer funds.
The GAO’s recommendations now call for stronger verification systems and clearer notifications to help ensure that marketplace consumers remain aware of and in control of their health coverage choices.
