Late night, hot off the press information from your favorite “pompous windbag!” This absolutely could not wait until tomorrow. Here’s some news sure to get some opinions… please share yours!
Well, this is certainly interesting!
On October 27, thirteen U.S. senators, led by Ron Wyden and Bernie Sanders, launched a formal inquiry into ten major health insurers, including Centene, over their participation in a federal initiative that canceled approximately 315,000 ACA Marketplace enrollments covering more than 760,000 people.
CMS says the enrollments were unauthorized and estimates approximately $2.2 BILLION in recovered premium tax credits.
You might say, “Hey, this sounds like a victory against fraud, right?” But WAIT… Not so fast. According to the senators' inquiry, insurers cooperated with CMS by contacting members and requesting additional personal information, sometimes including Social Security numbers. Members who failed to respond were allegedly included in lists used to terminate coverage.
The senators question whether those actions complied with federal requirements governing midyear eligibility determinations.
And here's the particularly interesting part. CMS didn't update the relevant guidance until October 1. The coverage cancellations were effective August 31. The senators want to know what legal authority the insurers relied upon when they participated.
Now, fraud in the ACA Marketplace is a legitimate concern. Nobody should be defending fraudulent enrollments.
But here's a question:
Since when does not answering an unsolicited communication constitute proof of fraud?
No medical claims? Maybe the person was healthy. Zero-dollar premium? That's how subsidies work. Didn't respond to a request for personal information? Perhaps they thought it was a scam. None of those circumstances, by themselves, establishes that someone fraudulently obtained coverage.
And this is where Centene enters the picture.
Centene operates one of the nation's largest ACA Marketplace businesses.
Its own October 27 earnings release shows Marketplace membership declining from 5.83 million to 3.40 million year over year, a roughly 42% reduction.
To be clear, there's no evidence establishing how many of those departures resulted from this federal initiative. The 760,000 figure covers multiple insurers, not just Centene.
But that makes the next questions even more important.
Congress is asking insurers to explain:
What evidence was used to identify supposedly unauthorized enrollments?
Did insurers consider whether legitimate members might be wrongly terminated?
How many affected members subsequently sought reinstatement or submitted medical claims?
Were children included in the termination lists?
Did the companies evaluate the legal basis for CMS's requests before cooperating?
Are they participating in another round of terminations?
Centene has until November 6 to respond to the inquiry.
And here's what I'd really like to know. Centene requires its employees to complete annual Compliance, Ethics, and Fraud, Waste & Abuse training.
We were taught to recognize suspicious activity, follow established procedures, document decisions, and escalate concerns. So what did Centene's own Compliance and Legal teams conclude about the evidence and procedures behind these cancellations? Did they independently evaluate the risk of terminating legitimate members? Or did they simply rely on CMS's assurances?
We don't know. That's why Congress is asking. And no, a congressional inquiry isn't proof that Centene broke the law. But the distinction between suspected fraud and proven fraud matters enormously when the consequence is losing health insurance… talk about “changing lives” amirite? But hey… margin.
Here's the bottom line.
If an insurer can help remove someone from coverage based on questionable indicators, who is responsible for proving the decision was justified? CMS? The insurance company? The broker? Or does the burden somehow fall on the person who just discovered they no longer have health insurance?
Fraud prevention requires evidence. So does accountability.
And if we're going to terminate someone's healthcare coverage in the name of protecting taxpayers, perhaps demonstrating that the person actually did something wrong shouldn't be an optional step. But hey, at least somebody is asking the questions!
SOURCES:
U.S. Senate — October 27, 2026
Wyden, Sanders and 11 Senate colleagues announce inquiry into ten insurers, including Centene:
https://www.wyden.senate.gov/news/press-releases/wyden-sanders-senate-democrats-call-out-insurance-company-collusion-with-trump-administration-to-kick-thousands-of-americans-off-health-insurance
CMS — September 22, 2026
Federal Marketplace Anti-Fraud Actions:
https://www.cms.gov/newsroom/fact-sheets/federal-marketplace-ffe-sbe-fp-anti-fraud-actions
Centene — October 27, 2026
Q3 2026 earnings and Marketplace membership:
https://investors.centene.com/2026-10-27-CENTENE-CORPORATION-REPORTS-THIRD-QUARTER-2026-RESULTS
Fierce Healthcare — October 27, 2026
Democratic senators probe insurers' role in canceling ACA coverage for 760K:
https://www.fiercehealthcare.com/payers/democratic-senators-probe-insurers-role-canceling-aca-coverage-760k