Paragon Health Institute

DOJ just exposed a $161.9M Obamacare fraud scheme. But this is just the tip of the iceberg—total exchange fraud could exceed $20B in 2024 alone. How did this happen? Weak oversight & bad policy. How does it work? ?? Brokers get per-person commissions & bonuses for signups ?? No real income verification = easy fraud ?? Insurers profit from inflated enrollments & look the other way Congress must let the ACA’s enhanced subsidies expire. They create built-in fraud incentives. Letting them expire in 2025 is the only way to stop this taxpayer-funded scam. https://lnkd.in/eX2fs2ST

?? My NEWEST ?? 'DOJ Confirms Florida's Rampant Exchange Fraud:' A massive exchange enrollment fraud scheme that scammed taxpayers out of “at least $161.9 million in government subsidies.” Link: https://lnkd.in/e-M_zJU7 Fraudsters like Lloyd and Strong (named in the suit) intentionally prey on low-income Americans to keep the scam running. According to the DOJ: "[Lloyd and Strong] targeted vulnerable, low-income individuals experiencing homelessness, unemployment, and mental health and substance abuse disorders, and, through ‘street marketers’ working on their behalf, sometimes offered bribes to induce those individuals to enroll in subsidized ACA plans." These brokers then coached applicants on how to maximize subsidies, while insurers—who profit from higher enrollments—have incentives to turn a blind eye to all these new enrollments. As a result of these ruthless and greedy tactics, many victims ended up with disruptions in medical care, unknowingly enrolled in plans that did not fit their needs, and canceled plans that covered their medications and doctors. Incredibly timely as today CMS released the "2025 Marketplace Integrity and Affordability Proposed Rule.” From CMS: https://lnkd.in/eFvqWzYG

??Who benefits most from the ACA? Not consumers. Brian Blase explains why insurers are the real winners, making more money than ever while providing low-value plans to Americans. Watch Brian's full appearance on KFF's The Health Wonk Shop here?? https://lnkd.in/eVmjjj_F

Important perspective from Brian Blase

Medicaid has a major problem and "the health-care industry doesn’t want to change anything, and States don’t want to change anything" Paragon's Brian Blase is quoted in The Washington Post on Medicaid's financing gimmicks. https://lnkd.in/eA6Yq-xF

Medicaid dominates long-term care—but at what cost? ?? Stephen Moses explains how flawed policies discourage private financing and strain public resources in McKnight's Long-Term Care News. https://lnkd.in/efyCMp3u

Medicaid made an estimated $1.1 TRILLION in improper payments over the past decade. That’s double the official $543B figure—because the Obama & Biden administrations failed to audit eligibility. What went wrong? ? Audits skipped eligibility reviews for 8 of the past 10 years ? Many enrollees weren’t even eligible ? States & insurers profited from misclassification & misspending Congress must act now. Strengthening eligibility reviews, enforcing existing laws, & holding states accountable could save taxpayers hundreds of billions—while ensuring Medicaid serves the truly needy. Read our joint policy brief with EPIC for more on the matter?? https://lnkd.in/eiC2XzFY

ICYMI: On KFF’s The Wonk Shop, Paragon’s Brian Blase explains how enhanced ACA subsidies drive up costs and fuel fraud. Watch the clip & read more on the issue here ?? https://lnkd.in/dzbe3ZU9

??NEW Paragon Pic?? Federal Medicaid spending projections jumped by $685B between CBO’s 2021 and 2024 baselines. Why? Biden’s policies extended enrollment for ineligible people & validated state financing gimmicks. ??Key drivers of the Medicaid surge: ??COVID-era policies that kept ineligible people enrolled ??Biden policies to keep ineligible people enrolled even longer ??State “money laundering” schemes that inflate Medicaid costs Budget proposals should target wasteful federal Medicaid expenditures. Biden’s spending surge needs to be rolled back to restore fiscal sanity. https://lnkd.in/eTiD3gSf

The current welfare system encourages dependence. Paragon’s Gary Alexander argues for reforms that promote independence and fiscal responsibility. Full National Review op-ed here?? https://lnkd.in/e_MszJuC