Insurance Brokerage Executive Pleads Guilty in $133.9 Million Affordable Care Act Fraud Scheme
The U.S. Department of Justice announced on April 18 that Dafud Iza, an executive vice president of a Florida insurance brokerage firm, pleaded guilty that day for his role in a scheme to submit fraudulent applications enrolling consumers in Affordable Care Act plans that were fully subsidized by the government. The Justice Department said the purpose of the scheme was to obtain millions of dollars in commission payments from the insurance company that operated the plans, and that the federal government paid at least $133.9 million in subsidies for fraudulently enrolled individuals.
According to court documents, Iza, 54, participated in a scheme to fraudulently enroll ineligible individuals into ACA plans that offered tax credits to eligible enrollees; the credits, or subsidies, could be paid by the federal government directly to insurance plans toward monthly premiums. The scheme involved submitting false and fraudulent applications for individuals whose income did not meet the minimum requirements for the subsidies: Iza and his accomplices deceptively marketed subsidized plans to ineligible consumers and falsely inflated consumers' incomes to obtain the subsidies.
The Justice Department said Iza and his accomplices targeted vulnerable, low-income individuals experiencing homelessness, unemployment, and mental health and substance abuse disorders, and knew that street marketers working on their behalf offered bribes to induce those individuals to enroll. Marketers also coached consumers on how to answer application questions to maximize the subsidy amount and provided addresses and Social Security numbers that did not match the consumers purportedly applying.
Iza pleaded guilty to one count of major fraud against the United States and faces a maximum penalty of 10 years in prison; a federal district judge will determine any sentence after considering the Sentencing Guidelines and other statutory factors. The case was announced by Matthew R. Galeotti, head of the Justice Department's Criminal Division, together with the FBI, the Department of Health and Human Services Office of Inspector General, and IRS Criminal Investigation officials in Miami; the three agencies are investigating the case, and Jamie de Boer and D. Keith Clouser of the Criminal Division's Fraud Section are prosecuting it. (Source: U.S. Department of Justice)
Source: U.S. Department of Justice
Published by GSM · USA (original Chinese edition)
Photo: 图：位于华盛顿的美国司法部总部罗伯特·F·肯尼迪司法部大楼（资料图）。图：Baseball Watcher，CC BY-SA 3.0，via Wikimedia Commons / Photo: The Robert F. Kennedy Department of Justice Building, headquarters of the U.S. Department of Justice, in Washington, D.C. (file photo). Photo: Baseball Watcher, CC BY-SA 3.0, via Wikimedia Commons
