Source: United States Department of Justice Criminal Division
PENSACOLA, FLORIDA – Malcolm Terrell Louis, 40, of Pensacola, was sentenced to 17 years in federal prison after previously pleading guilty to two counts of possession with intent to distribute 5 grams of more of methamphetamine, cocaine, and marijuana, two counts of possession of a firearm in furtherance of a drug trafficking offense, and two counts of possession of a firearm by a convicted felon.
Source: United States Department of Justice Criminal Division
COLUMBIA, S.C. — Jalik Shykeil Tucker, 31, of Sumter, has been sentenced to more than 19 years in federal prison for possession with the intent to distribute 500 grams or more of methamphetamine, 40 grams or more of fentanyl, and a quantity of cocaine and crack cocaine.
Source: United States Department of Justice Criminal Division
Tampa, FL – A federal jury has found Nidia Roxana Maradiaga-Flores (28), an illegal alien from Honduras, guilty of aggravated identity theft, false representation of a Social Security number, and making a false claim of United States citizenship for employment purposes. Maradiaga-Flores faces a maximum penalty of 12 years in federal prison. Her sentencing hearing is scheduled for April 17, 2026. U.S. Attorney Gregory Kehoe made the announcement.
Source: United States Department of Justice Criminal Division
Tampa, Florida – Terrance Bradford (47, Tampa) was sentenced by U.S. District Judge Virginia M. Hernandez Covington to 30 months in federal prison for obtaining multiple fraudulent COVID relief loans. As part of his sentence, the court also entered an order of forfeiture of $533,648.32, which represents the proceeds he obtained through these offenses. U.S. Attorney Gregory W. Kehoe made the announcement.
Source: United States Department of Justice Criminal Division
The Justice Department, acting on referral from the Federal Trade Commission (FTC), announced today that a federal court has entered a stipulated order resolving a case against Dun & Bradstreet Inc., doing business as D&B. Under the court’s order, Dun & Bradstreet will pay a $2,063,000 civil penalty and $2,785,786 in customer refunds, in addition to $924,590 of refunds it has already issued, to resolve allegations that it violated an FTC order.
The FTC entered an administrative order against Dun & Bradstreet in 2022 based on alleged unfair or deceptive business practices prohibited by the FTC Act. According to a complaint filed in the Middle District of Florida, Dun & Bradstreet violated provisions of that order requiring it to (1) accurately notify customers of the automatic renewal prices of its products; (2) not misrepresent its products; and (3) create and maintain records of its compliance with the order. The complaint alleges that in connection with its sale of credit-related services to small businesses, Dun & Bradstreet sent many of its customers inaccurate pricing notices, omitted or misrepresented certain facts about its products during sales calls, and failed to retain all of the call recordings required by the order.
“The Justice Department is committed to ensuring that American small businesses receive accurate information about the products and services they purchase,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “The Department will continue to work with the FTC to enforce its orders and hold violators accountable.”
“Our signed orders are not suggestions,” said Director Christopher Mufarrige of the FTC’s Bureau of Consumer Protection. “This settlement is another example of the Bureau’s effort to reinvigorate its fraud program and protect small businesses from deceptive and unlawful conduct.”
The United States is represented in this action by Senior Trial Attorney Sarah Williams and Assistant Director Zachary A. Dietert from the Enforcement Section of the Civil Division’s Enforcement and Affirmative Litigation Branch. Assistant U.S. Attorney Lacy R. Harwell, Jr. for the Middle District of Florida provided assistance. Christopher J. Erickson and Taylor H. Bates represent the FTC.
For more information about the Enforcement Section of the Civil Division’s Enforcement and Affirmative Litigation Branch, visit www.justice.gov/civil/enforcement-affirmative-litigation-branch.
Source: United States Airforce
Two MH-139A Grey Wolf helicopters assigned to the 40th Helicopter Squadron conducted their first operational Minuteman III ICBM convoy, marking an important milestone in the modernization of AFGSC’s nuclear security operations.
Source: United States Department of Justice Criminal Division
HONOLULU – United States Attorney Ken Sorenson announced that Travis Kalani Hong-Ah Nee, 36, of Oahu, was sentenced on January 12 in federal court by Senior United States District Judge J. Michael Seabright to a total of 78 months in federal prison followed by 5 years of supervised release after pleading guilty to conspiring to distribute and possess with intent to distribute carfentanil, possessing with intent to distribute carfentanil, and possessing ammunition after having been previously convicted of a felony.
Source: United States Department of Justice Criminal Division
Affiliates of Kaiser Permanente, an integrated healthcare consortium headquartered in Oakland, California, have agreed to pay $556 million to resolve allegations that they violated the False Claims Act by submitting invalid diagnosis codes for their Medicare Advantage Plan enrollees in order to receive higher payments from the government.
The settling Kaiser Permanente affiliates are Kaiser Foundation Health Plan Inc.; Kaiser Foundation Health Plan of Colorado; The Permanente Medical Group Inc.; Southern California Permanente Medical Group; and Colorado Permanente Medical Group P.C. (collectively Kaiser).
Under the Medicare Advantage (MA) Program, also known as Medicare Part C, Medicare beneficiaries may opt out of traditional Medicare and enroll in private health plans offered by insurance companies known as Medicare Advantage Organizations, or MAOs. The Centers for Medicare & Medicaid Services (CMS) pays the MAOs a fixed monthly amount for each Medicare beneficiary enrolled in their plans. CMS adjusts these monthly payments to account for various “risk” factors that affect expected health expenditures for the beneficiary. In general, CMS pays MAOs more for sicker beneficiaries expected to incur higher healthcare costs and less for healthier beneficiaries expected to incur lower costs. To make these “risk adjustments,” CMS collects medical diagnosis codes from the MAOs. The diagnoses must be supported by the medical record of a face-to-face visit between a patient and a provider, and for outpatient visits, must have required or affected patient care, treatment, or management at the visit.
Kaiser owns and operates MAOs that offer MA plans to beneficiaries across the country. In a complaint filed in the Northern District of California in October 2021, the United States alleged that Kaiser engaged in a scheme in California and Colorado to improperly increase its risk adjustment payments. Specifically, the United States alleged that Kaiser systematically pressured its physicians to alter medical records after patient visits to add diagnoses that the physicians had not considered or addressed at those visits, in violation of CMS rules.
“More than half of our nation’s Medicare beneficiaries are enrolled in Medicare Advantage plans, and the government expects those who participate in the program to provide truthful and accurate information,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “Today’s resolution sends the clear message that the United States holds healthcare providers and plans accountable when they knowingly submit or cause to be submitted false information to CMS to obtain inflated Medicare payments.”
“Medicare Advantage is a vital program that must serve patients’ needs, not corporate profits,” said U.S. Attorney Craig H. Missakian for the Northern District of California. “Fraud on Medicare costs the public billions annually, so when a health plan knowingly submits false information to obtain higher payments, everyone — from beneficiaries to taxpayers — loses. We have an obligation to protect the American taxpayer from waste, fraud, and abuse and we will relentlessly pursue individuals and organizations that compromise the integrity of the Medicare program.”
“The federal government supports the health care of millions of beneficiaries by paying hundreds of billions of dollars every year to Medicare Advantage Plans,” said U.S. Attorney Peter McNeilly for the District of Colorado. “Medicare relies on the accuracy of the information submitted by those plans. This resolution sends a clear message that we will hold health care plans accountable if they seek to game the system and pad their profits by submitting false information.”
“Deliberately inflating diagnosis codes to boost profits is a serious violation of public trust and undermines the integrity of the Medicare Advantage program,” said Acting Deputy Inspector General for Investigations Scott J. Lampert at the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “This outcome demonstrates HHS-OIG’s commitment to protecting Medicare through a unified approach — leveraging the expertise of our investigators, auditors, and counsel, alongside our law enforcement partners. We will continue to hold accountable any entity that seeks to compromise the integrity of the risk adjustment program.”
“Healthcare programs funded by the public are meant to support patients, not pad corporate bottom lines. False claims and the submission of fraudulent information weaken the Medicare system and place an unfair cost on American taxpayers who expect honesty and accountability,” said Special Agent in Charge Sanjay Virmani of the FBI San Francisco Field Office. “This settlement reflects the FBI’s continued commitment to holding accountable those who put profits over patients and abuse federal healthcare programs.”
The settlement announced today resolves allegations that, from 2009 to 2018, Kaiser engaged in a scheme to increase its Medicare reimbursements by pressuring physicians to add diagnoses after patient visits through “addenda” to patients’ medical records. The United States alleged that Kaiser developed various mechanisms to mine a patient’s past medical history to identify potential diagnoses that had not been submitted to CMS for risk adjustment. Kaiser then sent “queries” to its providers urging them to add these diagnoses to medical records via addenda, often months and sometimes over a year after visits. In many instances, the United States alleged, the diagnoses added by the providers had nothing to do with the patient visit in question, in violation of CMS requirements.
The United States further alleged that Kaiser set aggressive physician- and facility-specific goals for adding risk adjustment diagnoses. It alleged that Kaiser singled out underperforming physicians and facilities and emphasized that the failure to add diagnoses cost money for Kaiser, the facilities, and the physicians themselves. It also alleged that Kaiser linked physician and facility financial bonuses and incentives to meeting risk adjustment diagnosis goals.
The United States alleged that Kaiser knew that its addenda practices were widespread and unlawful. Kaiser ignored numerous red flags and internal warnings that it was violating CMS rules, including concerns raised by its own physicians that these were false claims and audits by its own compliance office identifying the issue of inappropriate addenda.
The civil settlement includes the resolution of certain claims brought in lawsuits under the qui tam or whistleblower provisions of the False Claims Act by Ronda Osinek and James M. Taylor, M.D., former employees of Kaiser. Under those provisions, private parties are permitted to sue on behalf of the United States and receive a portion of any recovery. The qui tam cases are captioned United States ex rel. Osinek v. Kaiser Permanente, et al., No. 3:13-cv-03891 (N.D. Cal.) and United States ex rel. Taylor v. Kaiser Permanente, et al., No. 3:21-cv-03894 (N.D. Cal.). The relator share of the recovery will be $95 million.
The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section and the U.S. Attorneys’ Offices for the Northern District of California and the District of Colorado, with assistance from HHS-OIG, HHS-Office of Audit Services, and the FBI.
The investigation and resolution of this matter illustrate the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement, can be reported to the Department of Health and Human Services at www.oig.hhs.gov/fraud/report-fraud/ or 800-HHS-TIPS (800-447-8477).
The matter was handled by Fraud Section Attorneys Braden Civins, Edward Crooke, Gary Dyal, Michael R. Fishman, Martha Glover, Seth W. Greene, Rachel Karpoff, Laurie Oberembt, and Jonathan Thrope, Assistant U.S. Attorney Michelle Lo for the Northern District of California, and Assistant U.S. Attorney Kevin Traskos for the District of Colorado.
The claims resolved by the settlement are allegations only and there has been no determination of liability.
Source: United States Department of Justice Criminal Division
PROVIDENCE – A citizen of Jamaica and resident of Georgia has pleaded guilty in federal court in Rhode Island to charges related to his role in a nationwide sweepstakes fraud scheme that targeted elderly victims, announced United States Attorney Charles C. Calenda.
Source: United States Department of Justice Criminal Division
Seattle – A 25-year-old Federal Way, Washington man was sentenced today in U.S. District Court in Seattle to eight years in prison for using a firearm in a crime of violence, announced U.S. Attorney Charles Neil Floyd.