GAO Finds CMS Marketplace Controls Fail to Prevent Unauthorized Agent Enrollment Actions
A Government Accountability Office report released July 13, 2026 finds that CMS lacks adequate controls to prevent health insurance agents and brokers from making unauthorized enrollments and plan switches in the federal Health Insurance Marketplace. Consumer complaints of confirmed unauthorized activity grew more than fourfold from 2023 through 2025, with at least 160,000 applications in plan year 2024 showing likely unauthorized changes. While CMS implemented new consent procedures in 2024, GAO found they do not prevent all unauthorized actions because they are not consistently applied and identity verification is limited. CMS is exploring additional controls for the 2027 open enrollment period but has not finalized decisions.
Medicaid managed care organizations operating dual-eligible special needs plans or serving populations transitioning between Medicaid and Marketplace coverage face heightened enrollment integrity risk and potential regulatory scrutiny as CMS addresses broker fraud vulnerabilities that undermine consumer protections across its programs.
Managed Care
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