Updated

Updated · Fox News · Jun 26

Trump Administration Removes 3 Million Obamacare Enrollees in $10 Billion Fraud Crackdown

Updated

Updated · Fox News · Jun 26

Trump Administration Removes 3 Million Obamacare Enrollees in $10 Billion Fraud Crackdown

Q: Beyond removing enrollees, what new technology is being used to prevent billions in healthcare fraud from recurring?

The main new tool is AI-driven fraud detection, paired with advanced data analytics and machine learning to stop improper payments before they go out. HHS and CMS are moving beyond a “pay-and-chase” approach toward a “detect-and-prevent” model. Under CMS’s CRUSH initiative, AI systems review enrollment and claims data in real time to flag suspicious patterns such as phantom enrollments, duplicate coverage, implausible billing spikes, inconsistent income information, and broker-driven unauthorized sign-ups. The technology is designed to identify outliers early, allowing officials to suspend payments, revoke billing privileges, or cancel unauthorized enrollments before taxpayer money is lost. The system is also being strengthened with cloud-based analytics, integrated federal data repositories, and broader data-sharing across agencies. That allows CMS, HHS-OIG, DOJ and other partners to compare enrollment, subsidy, Medicaid and claims records more quickly and spot fraud schemes that older manual reviews often missed. In practical terms, the anti-fraud push is combining restored income verification and tighter enrollment rules with AI-based predictive analysis, automated risk scoring, and continuous monitoring. Officials say that is the key change meant to prevent the billions in alleged ACA and broader healthcare fraud from recurring, rather than simply removing fraudulent enrollees after the fact.

1 articles · Updated · Fox News · Jun 26

Nearly 3 million Affordable Care Act enrollees have been removed after HHS said a fraud review found improper, phantom and other suspect sign-ups, with 2.6 million more cases still targeted.
The administration says the abuse cost taxpayers about $10 billion from 2021 to 2024 after Obamacare enrollment jumped from 10 million at the start of Biden's term to a 22 million peak in 2024.
HHS said relaxed income and eligibility checks, broader year-round enrollment, misstated incomes and broker-driven "phantom enrollments" let ineligible people receive subsidized coverage.
About 19.2 million people remain on the rolls after the purge, and officials say they have restored income verification, checked duplicate Medicaid enrollment and moved against brokers accused of fraud.
The crackdown lands as Republicans remain divided over how to reform or replace Obamacare, turning program integrity into a broader fight over healthcare costs and federal spending.

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Right100%

Fox News3h ago

Trump Administration Removes Millions from Obamacare Rolls Amid $10 Billion Fraud Crackdown

With enrollment falling and insurers exiting, can the ACA marketplace remain stable while undergoing this massive anti-fraud correction?

As millions are cut from health rolls, what safeguards protect eligible families from mistakenly losing their essential coverage?

Beyond removing enrollees, what new technology is being used to prevent billions in healthcare fraud from recurring?

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1 total

Right100%

Fox News3h ago

Trump Administration Removes Millions from Obamacare Rolls Amid $10 Billion Fraud Crackdown

Trump Administration Removes 3 Million Obamacare Enrollees in $10 Billion Fraud Crackdown

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