The US House of Representatives Judiciary Committee has issued subpoenas to eight health insurers demanding documentation on fraud protection measures
The subpoenas come amid a Government Accountability Office study identifying $21 billion in unreconciled tax credits and $27 billion in annual improper payments within the Affordable Care Act marketplace.
The GAO report revealed that 32% of all advance premium tax credits paid to identifiable Social Security number holders in 2023 – totaling $21 billion – showed no evidence of tax reconciliation, the committee said. GAO analysis indicates no reconciliation means no accountability or verification of whether recipients were eligible for subsidies.
The unreconciled amount represents approximately 17% of the nearly $124 billion in premium tax credits distributed to 19.5 million enrollees in 2024, government data shows. Federal subsidy costs have surged from $18 billion in 2014 to an estimated $138 billion in 2025, the Committee for a Responsible Federal Budget reported.
The subpoenaed insurers are Blue Shield of California, Centene Corp., CVS Health Corp., Elevance Health Inc., GuideWell, Health Care Services Corp., Kaiser Permanente and Oscar Health Inc.
The GAO study uncovered widespread system vulnerabilities beyond unreconciled credits. Investigators found 58,000 Social Security numbers receiving subsidies matched Social Security death data, resulting in $94 million in taxpayer-funded subsidies sent to health insurers on behalf of deceased individuals.
One Social Security number was used on applications for over 125 insurance policies totaling more than 26,000 days of coverage – the equivalent of 71 years – in 2023, the report showed. An additional 66,000 Social Security numbers in 2024 had more than one year's worth of subsidized coverage.
GAO's covert testing demonstrated system failures: 100% of fake applicants were approved in late 2024, with 18 of 20 fake identities still receiving subsidized coverage for 2025. Monthly subsidies paid to insurers on behalf of GAO's fabricated identities exceeded $12,300.
Unreconciled tax credits occur when marketplace enrollees who received advance premium tax credits fail to file IRS Form 8962 reconciling projected income used to determine subsidy eligibility against actual annual income.
Taxpayers must reconcile differences between advance credits paid directly to insurers and actual premium tax credits they qualify for based on final income.
GAO analysis revealed it could not identify reconciliation evidence in IRS tax data as of April 2025 for over $21 billion in credits for enrollees who provided Social Security numbers through the federal marketplace in plan year 2023.
The Trump administration issued Marketplace Integrity and Affordability rules in June 2025 that included fraud protection measures, but a federal court stayed the rules for violating the Administrative Procedures Act. A Maryland federal judge blocked portions in August that would have changed enrollment and verification requirements.
A GuideWell spokesperson said the company was cooperating with committee inquiries. "We are committed to fostering a health care system that prioritizes trust, transparency, affordability and accessibility for all," the spokesperson said.
