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House Judiciary Subpoenas Eight Insurers in ACA Subsidy Fraud Probe

Findings from a recent GAO report on subsidy irregularities guide the committee’s push for potential legislative fixes.

Overview

  • Committee leaders sent subpoenas on Feb. 9 to Blue Shield of California, Centene, CVS Health, Elevance Health, GuideWell, Health Care Service Corp., Kaiser Permanente and Oscar Health.
  • Insurers must produce records by Feb. 23 covering fraud-prevention practices, subsidy data and audits after incomplete responses to December information requests.
  • A December GAO report cited billions in unreconciled ACA subsidies and flagged 58,000 Social Security numbers matching death records, including about $94 million paid on behalf of deceased individuals.
  • CMS proposed a rule on Feb. 9 to tighten eligibility verifications and revive integrity checks after a 2025 rule was stayed by a federal judge, with that case on appeal.
  • Lawmakers say insurer responses will shape potential legislation and a review of APA procedures, noting APTCs are paid directly to insurers in a way that can distort incentives.