Obamacare Fraud, by the Numbers

Paragon research has exposed two major problems in the Obamacare exchanges: improper enrollment and zero-claim enrollees.

Improper enrollees are enrollees signed up for fully subsidized plans at the conclusion of open enrollment claiming incomes between 100 and 150 percent of the federal poverty level, even though they do not actually earn that amount.

Zero-claim enrollees are people enrolled at any point during the year who did not use their health plan at all—no doctor visit, no lab test, and no prescription filled.

Improper enrollees

Improper enrollees as a percentage of all enrollees

Federal spending on improper enrollees

Percentage of enrollees who were automatically re-enrolled

Note: A large part of the fraud in 2025 was the automatic renewal of coverage for people who were improperly enrolled in previous years.

Enrollees with unknown race or ethnicity on their application

Number of zero-claim enrollees

Percentage of all enrollees with zero claims

Percentage of fully-subsidized enrollees in 94% actuarial value plans with zero claims

Federal spending on zero-claim enrollees

Three notes:

• The improper enrollment numbers reflect sign-ups after open enrollment.
• The Congressional Budget Office estimated 2.3 million improper enrollees in 2025, but this only included data from the 10 states that have not adopted Medicaid expansion.
• Zero-claim enrollees include anyone enrolled at any point during the year. It could include people twice if they were enrolled in two different plans during the year.