President of Insurance Brokerage Firm and CEO of Marketing Company Charged in $161M Affordable Care Act Enrollment Fraud Scheme
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President of Insurance Brokerage Firm and CEO of Marketing Company Charged in
An indictment was unsealed today charging
ACA plans offer tax credits to eligible enrollees. These tax credits, or "subsidies," could be paid by the federal government directly to insurance plans in the form of a payment toward the applicable monthly premium. According to court documents, Lloyd and Strong conspired to enroll consumers in ACA plans that were fully subsidized by the federal government by submitting false and fraudulent applications for individuals whose income did not meet the minimum requirements to be eligible for the subsidies. Lloyd allegedly received commission and other payments from an insurance company in exchange for enrolling consumers in the ACA plans. In turn, Lloyd allegedly paid commissions to Strong in exchange for consumer referrals.
As alleged in the indictment, 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. Marketers working for Strong's company allegedly coached consumers on how to respond to application questions to maximize the subsidy amount and provided addresses and social security numbers that did not match the consumers purportedly applying. As a result of being enrolled in subsidized ACA plans for which they did not qualify, some of these consumers experienced disruptions in their medical care.
The indictment alleges that Lloyd and Strong used misleading sales scripts and other deceptive sales techniques to convince consumers to state that they would attempt to earn the minimum income necessary to qualify for a subsidized ACA plan, even when the consumer initially projected having no income. Lloyd and Strong also allegedly conspired to bypass the federal government's attempts to verify income and other information. Lloyd and Strong allegedly engaged in the scheme to maximize the commission payments they received from insurers, resulting in their companies' receiving millions of dollars in commissions.
As alleged in the indictment, Lloyd and Strong's scheme caused the federal government to pay at least
Supervisory Official
The
Assistant Chief
The Fraud Section leads the Criminal Division's efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since
An indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
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Original text here: https://www.justice.gov/opa/pr/president-insurance-brokerage-firm-and-ceo-marketing-company-charged-161m-affordable-care
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