Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"September 22, 2026 4 min read
Add topic to email alerts
Receive an email when new articles are posted on
Please provide your email address to receive an email when new articles are posted on . “
data-action=”subscribe”>
Subscribe
We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: CMS announced aggressive action against fraud, canceling ACA coverage for 760,000 people. There will also be a national moratorium on new brokers for the next 6 months. CMS said it is taking action to combat alleged fraud in the Affordable Care Act program. One expert told Healio the move could further strain the nation\u2019s healthcare system.
CMS is taking aggressive action to target alleged fraud in the Affordable Care Act program. Source: Adobe Stock
In a press conference Tuesday, Vice President JD Vance and CMS administrator Mehmet Oz, MD, announced CMS is canceling 315,000 \u201cunauthorized enrollments,\u201d removing coverage for more than 760,000 people believed to be fraudulently enrolled in the ACA. \u201cWe are announcing $2.2 billion in American taxpayer money that we\u2019re saving by doing this amazing common sense and what should have been an obvious thing: We\u2019re actually making sure that people receiving Obamacare subsidies are actually entitled to receive them,\u201d Vance said. CMS is also seeking additional verification for 419,000 other beneficiaries, Vance said. \u201cWe\u2019re going to make sure that they\u2019re, first of all, legal residents of the United States of America and, second of all, we\u2019re going to make sure that they actually meet the income threshold requirements in order to receive these Obamacare benefits,\u201d he said. Oz said CMS will be taking action to prevent improper or fraudulent enrollments upfront: a temporary national moratorium. \u201cIt has never been done before. There will be no new brokers for Obamacare in this country for the next 6 months,\u201d he said. \u201cWe do not feel at all conflicted about that decision because most of the fraud \u2014 a disproportionate amount of the fraud \u2014 is taking place from these individuals. So, if you have an active exchange agreement, you can keep in the system for now. We\u2019ll see about you. But the folks who are thinking of coming on down and taking advantage, they\u2019re not going to be in.\u201d According to a press release from CMS, the organization will also now require identity proof from all existing brokers and agents, require applications with brokers or agents to include a social security number or other verifiable documentation, require electronic consumer authorization before a broker or agent can act on a consumer\u2019s enrollment, and update the system to prevent brokers and agents \u201cfrom being added to applications that consumers should be completing on their own.\u201d Vance and Oz pointed to \u201cweakened guardrails\u201d during the COVID-19 pandemic as the impetus for the fraud. \u201cThe prior administration decided not to enforce the weakened guardrails,\u201d Oz said. \u201cAbout 35% of current people on the Obamacare system \u2014 more than a third \u2014 have never used the program. They haven\u2019t bought a prescription medication. They hadn\u2019t seen a doctor. That\u2019s just not possible.\u201d Arthur L. Caplan, PhD, professor emeritus and founding head of the division of medical ethics at NYU Grossman School of Medicine, told Healio that this \u201cfraud effort represents the administration\u2019s efforts to rein in cost and address the healthcare affordability issue,\u201d but it is misguided. \u201cThe administration continues to chase fraud as the problem, whereas it\u2019s pretty obvious that cost is the problem. Premiums are too high \u2014 people have had to drop out of the program. Coverage is not what it should be,\u201d Caplan said. \u201cThe administration continually focuses on fraud as the way to save money, but it is the dramatic increases in the costs of the program premiums related to the escalating costs from last year of healthcare that is the real core issue.\u201d He explained that seeking to cut fraud is a worthy goal, \u201cbut it\u2019s become politicized at this point.\u201d \u201cThe Republicans, if you will, see fraud everywhere. The Democrats see high prices and inadequate coverage as a result everywhere,\u201d he added. \u201cI think it would be nice in this area if they could get to some consensus and attack both.\u201d He also questioned pandemic-related fraud as the root of the issue and the moratorium decision. \u201cFraud was a problem during COVID. There were plenty of people who tried to rip off the government, but I don\u2019t think the ACA was particularly fraud-prone, if you will, at that time,\u201d he said. \u201cIn order to chase down fraud, you don\u2019t have to put a hold on the program and put people\u2019s health and lives at stake. I don\u2019t consider that necessary, and it seems to me it\u2019s morally dubious given the vulnerability that you\u2019re creating for new enrollees who need coverage … Continue to enroll people who need the program and then continue your investigations. It\u2019s not like you have to put the whole thing on hold.\u201d But regardless, Caplan said that the healthcare system will pay the price for CMS\u2019s decisions. \u201cAnything that cuts coverage for poor Americans means more strain on public facilities, emergency rooms, any place that people will go when they can\u2019t go to a physician themselves,\u201d he said. \u201cIt will strain our charitable safety net within the system, which involves, primarily, emergency care.\u201d For more information: Arthur L. Caplan, PhD, can be reached at primarycare@healio.com. Sources\/Disclosures Source:
Press Conference
References:
Disclosures:
Caplan reports no relevant financial disclosures.
Ask a clinical question and tap into Healio AI’s knowledge base.
PubMed, enrolling\/recruiting trials, guidelines
Clinical Guidance, Healio CME, FDA news
Healio’s exclusive daily news coverage of clinical data
Learn more
Add topic to email alerts
Receive an email when new articles are posted on
Please provide your email address to receive an email when<\/p>\n","protected":false},"author":1,"featured_media":3765,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3764","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3764","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3764"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3764\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3765"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3764"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3764"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3764"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}