New CMS data suggest future ACA market turmoil as feds crack down on fraud

Fierce Healthcare – Tuesday, August 12, 2025
By Noah Tong

The Centers for Medicare & Medicaid Services (CMS) this week released new data fueling a narrative of rampant broker fraud on the Affordable Care Act (ACA) exchanges.

Plans received data finding 23% of enrollees did not have a claim in 2019. That number jumped sharply to 35% last year.

Before the pandemic, the data were largely consistent across three categories: members on state-based exchanges, members on the federal exchange in Medicaid expansion states and on the federal exchange in non-expansion states. No matter the group, about 22% to 24% of enrollees did not have a claim.

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