Category: MIL-OSI

Source: United States Department of Justice Criminal Division

United States Attorney for the Southern District of New York, Jay Clayton, Director of the Federal Bureau of Investigation (“FBI”), Kash Patel, Assistant Director in Charge of the New York Field Office of the FBI, James C. Barnacle, Jr., and Commissioner of the New York City Police Department (“NYPD”), Jessica S. Tisch, announced today an eight-count indictment charging EMIR BALAT and IBRAHIM KAYUMI in connection with their alleged terrorist attack in Manhattan on March 7, 2026. 

Source: United States Department of Justice Criminal Division

A California man pleaded guilty yesterday to submitting nearly $270 million in fraudulent claims over an 11-month span to California’s Medicaid program (Medi-Cal) for expensive prescription drugs that were medically unnecessary and, in many instances, not provided to the purported recipients.

The Department of Justice announced this case and two others in support of President Trump’s Task Force to Eliminate Fraud at a press conference in Washington today.

“Thanks to the leadership of President Donald Trump, the Department, working closely with the Task Force to Eliminate Fraud, is supercharging efforts to take down every fraudster and bring them to justice,” said Acting Attorney General Todd Blanche. “In one day, the Department prosecuted the theft of a half-billion in taxpayer dollars. All those ripping off the American people are on notice.”

“The defendant was a repeat fraudster who caused Medi-Cal, a program designed to help those in need, to be billed nearly $270 million for expensive and medically unnecessary medications,” said Assistant Attorney General A. Tysen Duva of the Justice Department’s Criminal Division. “He and his co-schemers stole over $178 million through false and fraudulent claims for these medications, lining their own pockets with public funds. The Criminal Division will aggressively prosecute those who defraud Medicaid and exploit taxpayer-funded benefit programs.”

“This defendant used a public health program as his personal piggy bank,” said First Assistant U.S. Attorney Bill Essayli of the Central District of California. “This guilty plea should send a message that this administration — consistent with the President’s war on fraud — will not turn a blind eye while criminals fleece taxpayers.”

“Schemes that bill Medicaid for costly drugs that patients never needed or received threaten the integrity of the program,” said Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “This plea shows our firm resolve, alongside our law enforcement partners, to exposing such fraud operations, ensuring those responsible are held accountable, and safeguarding taxpayer-funded health care programs.”

According to court documents, Paul Randall, 66, of Orange, along with pharmacist and pharmacy owner Kyrollos Mekail, 37, of Moreno Valley, and nurse practitioner Patricia Anderson, 58, of West Hills, exploited Medi-Cal’s suspension of its requirement that health care providers obtain prior authorization before providing certain medications at the beginning of 2022. Medi-Cal temporarily suspended the requirement as part of a transition to a new payment system. Using a business called Monte Vista Pharmacy, which Mekail owned, Randall and his co-schemers billed Medi-Cal tens of millions of dollars per month for purportedly dispensing high-reimbursement drugs containing cheap, generic ingredients that were manufactured in unique dosages, combinations or package quantities and were not included in the applicable maximum price lists that cap Medi-Cal reimbursements.

In furtherance of the scheme, Randall paid illegal kickbacks to patient marketers in exchange for Medi-Cal beneficiary information and thereafter paid illegal kickbacks to Anderson to sign pre-filled prescriptions for 19 high-reimbursement, non-contracted, generic drugs. Anderson never met the patients, reviewed their medical records or otherwise determined that the medications were medically necessary before signing the prescriptions. The medications, which included pain creams and Folite tablets, a vitamin available over the counter, were billed for thousands of dollars each, including approximately $13,424 for one prescription of meloxicam 5 mg, a generic drug that typically costs between $5 and $25 for a 30-day supply in larger dosages.

Randall received a portion of Monte Vista’s reimbursements from Medi-Cal, at times equaling approximately 40% of Monte Vista’s profit from the false and fraudulent claims. Randall admitted in his plea agreement that he caused at least $269,120,829 in false and fraudulent claims to Medi-Cal from May 2022 to April 2023, of which Medi-Cal paid at least approximately $178,746,556. Randall also admitted that he committed the offense while on release in another criminal case.

Randall and others laundered their illicit proceeds by transferring the money to a third party to pay kickbacks to Anderson in an attempt to conceal the crime from law enforcement.

In his plea agreement, Randall agreed to forfeit property obtained from the fraud, including bank account balances exceeding $17 million, three vehicles, seven real properties, and sports memorabilia. To date, the government has seized approximately $126.5 million in assets that Randall and his co-schemers accumulated from the scheme, including $111 million in bank funds and securities, nine luxury vehicles totaling approximately $1 million, nine luxury real properties totaling approximately $13.5 million, and more than $1 million worth of sports memorabilia.

Randall pleaded guilty to one count of wire fraud. He is scheduled to be sentenced on August 3 and faces a maximum penalty of 30 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Relatedly, in August 2024, Mekail pleaded guilty to two counts of health care fraud and awaits sentencing. In April 2025, Anderson pleaded guilty to two counts of health care fraud and also awaits sentencing.

The FBI, HHS-OIG, and the California Department of Justice are investigating the case.

Assistant Chief Niall M. O’Donnell and Trial Attorney Siobhan M. Namazi of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Roger A. Hsieh for the Central District of California are prosecuting the case. Assistant U.S. Attorney James E. Dochterman for the Central District of California’s Asset Forfeiture and Recovery Section is handling asset forfeiture matters in this case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of eight strike forces operating in federal districts across the country, has charged more than 6,200 defendants who collectively have billed federal health care programs and private insurers more than $45 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.

Source: United States Department of Justice Criminal Division

AP of South Florida, LLC (APSF), an insurance brokerage company headquartered in Florida, has agreed to plead guilty for its role in an Affordable Care Act (ACA) enrollment fraud scheme.APSF, through its highest-ranking executives, preyed on thousands of vulnerable consumers to fraudulently enroll them into fully subsidized ACA plans, for which the federal government awarded $141.5 million in unwarranted subsidies. In a parallel civil resolution, AssuredPartners, Inc., a national partnership of insurance brokers and the then-parent company of APSF, agreed to pay $135 million to resolve allegations that it violated the False Claims Act by submitting fraudulent ACA health insurance plan applications. AssuredPartners, Inc., is not charged in the criminal information.

The Department of Justice announced this case and two others in support of President Trump’s Task Force to Eliminate Fraud at a press conference in Washington today.

“Thanks to the leadership of President Donald Trump, the Department, working closely with the Task Force to Eliminate Fraud, is supercharging efforts to take down every fraudster and bring them to justice,” said Acting Attorney General Todd Blanche. “In one day, the Department prosecuted the theft of a half-billion in taxpayer dollars. All those ripping off the American people are on notice.”

The Criminal Case

The federal government offers subsidies to help eligible beneficiaries pay for health insurance plans. These subsidies are offered as tax credits to beneficiaries or as payments to insurers as Advanced Premium Tax Credits (APTCs). APTCs are paid directly to insurance plans by the federal government in the form of a payment toward the beneficiary’s applicable monthly premium.

A criminal information was filed yesterday charging APSF with one count of major fraud against the United States. APSF has agreed to resolve the criminal charge by pleading guilty and paying restitution of $27.6 million. As part of its plea agreement, APSF admitted that, through certain of its executives and employees, APSF knowingly and intentionally defrauded the federal government. According to court documents, APSF targeted vulnerable, low-income individuals experiencing homelessness, unemployment, and mental health and substance abuse disorders, and, through “street marketers” working on APSF’s behalf, sometimes offered cash and gift cards to induce those individuals to enroll in subsidized ACA plans. APSF enrolled these vulnerable 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. As a result of being enrolled in subsidized ACA plans for which they did not qualify, some of these consumers experienced serious disruptions in their medical care or prior insurance coverage under Medicaid or other programs. Some consumers who APSF fraudulently enrolled into fully subsidized ACA plans lost access to free health benefits through Medicaid or local assistance programs, and as a result, these consumers faced increased costs in accessing HIV medication, medication to treat opioid dependence and medication to treat mental health disorders. At times, consumers faced unaffordable co-pays and other costs because APSF enrolled these consumers in plans without regard to the consumers’ medical needs, the availability of other programs (including Medicaid and local assistance programs) and the consumers’ ability to pay out-of-pocket costs.

“APSF defrauded the U.S. government in order to line their pockets by exploiting the vulnerable,” said FBI Director Kash Patel. “The FBI and its partners are working every day to put an end to corporate malpractice. We are turning off the spigot and other entities ripping off the taxpayer for illicit gain should take note.”

“As yesterday’s resolution demonstrates, the Criminal Division will pursue both corporate and individual actors that defraud the United States taxpayer and exploit consumers,” said Assistant Attorney General A. Tysen Duva of the Justice Department’s Criminal Division. “Together with our partners, we previously prosecuted the former President of APSF, who will serve 20 years in prison for his crimes. Yesterday, the Department is announcing that his employer, APSF, has agreed to plead guilty for its role in the scheme and will pay $27 million in restitution. For over a year, APSF made money on the backs of vulnerable consumers and by siphoning money from a critical social safety net meant to protect working families. The conduct was orchestrated by APSF’s highest ranking executive and was pervasive throughout the company. Open and notorious corporate frauds will not be tolerated.”

“Exploiting people in crisis to generate profit at the expense of taxpayers is unconscionable,” said Inspector General T. March Bell of the U.S. Department of Health and Human Services, Office of Inspector General (HHS‑OIG). “By manipulating the ACA marketplace and disrupting access to essential treatments, APSF compromised core federal health care protections and inflicted real harm on consumers who relied on those safeguards. HHS‑OIG will continue to work with our law enforcement partners to apply the full scope of our oversight and enforcement authorities to protect taxpayer dollars and consumers.”

“Yesterday’s action underscores that companies cannot enrich themselves by manipulating federal health care programs and exploiting vulnerable individuals,” said Chief Guy Ficco of IRS Criminal Investigation. “In this case, executives falsified eligibility information to drive millions in improper subsidies, turning a program meant to provide care into a source of illicit revenue. IRS Criminal Investigation traced the flow of funds behind this scheme, and we will continue to pursue those who misuse taxpayer dollars for personal gain.”

According to court documents, APSF received commissions and other payments from an insurance company in exchange for enrolling consumers in the ACA plans. In turn, APSF paid a street marketing company in exchange for consumer referrals. To maximize these commission payments, APSF 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 consumers initially stated to APSF’s insurance agents that they had no income. APSF also bypassed the federal government’s attempts to verify income and other information and deliberately a large volume of applications to Medicaid for various individuals in a way that guaranteed their denial so that they could sign up these same consumers for a fully subsidized ACA plan and maximize commissions.

APSF’s former president, Cory Lloyd, was previously convicted at trial in November 2025 for his role in the scheme and sentenced to twenty years’ imprisonment. According to court documents, Lloyd began the scheme at a legacy entity. In February 2021, APSF acquired certain assets of that legacy entity. Lloyd then became the President of APSF, where he continued to orchestrate the fraud scheme on behalf of APSF.

Evidence presented in Lloyd’s trial showed that, while President of APSF, he received complaints from a medical provider alerting Lloyd that multiple consumers, “who were homeless, were given cash to sign up” for these ACA plans. The provider further complained that: “All of them have opioid addiction and were desperate for money. All of them were unaware they had insurance until the provider tried to get them medications through the county hospital for uninsured patients. These people are worse off than if they had no insurance because they are being asked to pay >$500 per month for their medications.” Evidence presented in Lloyd’s trial also showed that, despite receiving such warnings, APSF continued to fraudulently enroll consumers in fully subsidized ACA plans by “bumping up” their income to make them appear qualified for subsidies.

A change of plea hearing for APSF will be set for a later date, where the terms of the plea agreement between APSF and the Department of Justice will be considered by a federal judge. If the plea agreement is accepted by the court, APSF will be sentenced by a federal district court judge at a later date.

The government reached its criminal resolution with APSF based on several factors, including the nature and seriousness of the offense conduct; the fact that the fraud began at a legacy entity whose assets were acquired by APSF in February 2021; APSF’s failure to conduct adequate acquisition diligence, oversee the acquired operations, and detect the open and pervasive fraudulent scheme, which allowed the conduct to persist at APSF for approximately 18 months after the asset acquisition; and the pervasiveness of the offense, which involved multiple former APSF employees and former members of its senior executive management, including its President (Lloyd), who personally conducted and promoted the scheme. APSF also did not voluntarily and timely self-disclose the conduct to the Department of Justice but did receive credit for clearly accepting responsibility for its criminal conduct, cooperating with the government’s investigation, and implementing remedial measures.

FBI, HHS-OIG and IRS-CI are investigating the criminal case.

Assistant Chief Jamie de Boer and Trial Attorney D. Keith Clouser of the Criminal Division’s Fraud Section are prosecuting the criminal case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of eight strike forces operating in federal districts across the country, has charged more than 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.

The Civil Case

The False Claims Act settlement resolves allegations that, from February 2021 through September 2022, APSF knowingly submitted false or fraudulent applications for subsidized ACA plans on behalf of thousands of consumers in order to obtain commissions and bonus payments from insurers. APSF contracted with “street marketers” who targeted homeless shelters, bus stops, drug treatment clinics and similar locations. The marketers offered incentives, such as cash or gift cards, to individuals to enroll in subsidized ACA plans or to provide their personal information so that APSF could submit applications on their behalf. APSF employees then submitted applications falsely representing that the consumers would make a minimum income amount just over the federal poverty line in order to cause the government to pay the highest subsidy amount.

APSF employees also knowingly submitted false information to Florida’s Medicaid program in order to generate letters stating that the applicant was denied Medicaid coverage and then used these letters as a qualifying event to trigger a Special Enrollment Period, which allowed APSF to submit applications for ACA plans outside of the normal enrollment periods. APSF employees also evaded the federal government’s attempts to verify information in consumers’ ACA applications by submitting false information in response to inquiries from the Centers for Medicare and Medicaid Services when it sought to verify the false information (including income information) submitted by APSF. Some consumers experienced disruptions in their medical care as a result of being enrolled by APSF in subsidized ACA plans that did not provide coverage for their medical needs. APSF received commissions, bonuses, and/or other payments for consumers it enrolled in ACA plans, and a significant portion of APSF’s revenues from these fraudulently obtained payments flowed up to its then-parent corporation, AssuredPartners.

“Federal benefit programs funded by American taxpayers provide an important safety net for vulnerable populations,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “Yesterday’s resolution sends the clear message that the United States will hold accountable actors who exploit those programs to enrich themselves at the expense of the public.”

“Our office will use all available tools, including the False Claims Act, to confront those who submit false claims under the Affordable Care Act,” said U.S. Attorney Gregory W. Kehoe for the Middle District of Florida. “This case exemplifies our dedication to protecting our nation’s taxpayers from fraud.”

“This $135 million resolution lays bare a brazen scheme that caused real harm by targeting vulnerable individuals for profit and disrupting their access to critical care,” said Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General (HHS‑OIG). “Because of APSF’s manipulation of individuals’ enrollment statuses, Medicaid and other programs intended to support vulnerable populations were undermined in fulfilling their mission. HHS-OIG will continue to aggressively pursue accountability for those who choose greed over patients and work to protect the integrity of public resources.”

The settlement resolves allegations originally brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government and to share in any recovery. The whistleblower will receive $24.3 million as their share of the recovery in this case.

The resolution obtained in the civil matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the U.S. Attorney’s Office for the Middle District of Florida, and the Department of Health and Human Services Office of Inspector General.

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 800-HHS-TIPS (800-447-8477).

The civil matter was handled by Attorneys Wendy Zupac and David Wiseman of the Civil Division’s Fraud Section, and Assistant U.S. Attorney Jeremy Bloor for the Middle District of Florida.

The Commercial Litigation Branch’s Fraud Section investigates complex health care fraud allegations and files suit under the civil False Claims Act to recover money on behalf of defrauded federal health care programs. Settlements and judgments under the False Claims Act exceeded $6.8 billion in the fiscal year ending Sept. 30, 2025. Working with United States Attorneys, investigative agencies, and whistleblowers, Fraud Section attorneys have recovered more than $85 billion in False Claims Act settlements and judgments since 1986.

The claims resolved by the civil settlement are allegations only and there has been no determination of liability in the civil settlement. 

Source: United States Department of Justice Criminal Division

BOSTON – A former accounting and real estate executive in Sudbury was sentenced yesterday in federal court in Boston for a multi-year scheme to cheat the Internal Revenue Service (IRS) by getting paid more than $1.6 million in compensation and fringe benefits under the table, all while lying to the U.S. Attorney’s Office about his income to avoid paying restitution he owed to victims of an earlier fraud scheme.

Source: United States Department of Justice Criminal Division

Today, the Department of Justice and the FBI announced a court-authorized technical operation to neutralize the U.S. portion of a network of small office/home office (SOHO) routers compromised by a unit within Russia’s Main Intelligence Directorate of the General Staff (GRU) Military Unit 26165, also known as APT28, Sofacy Group, Forest Blizzard, Pawn Storm, Fancy Bear, and Sednit. The unit used the routers to facilitate malicious Domain Name System (DNS) hijacking operations against worldwide targets of intelligence interest to the Russian government, including individuals in the military, government, and critical infrastructure sectors.

Since at least 2024, GRU actors have exploited known vulnerabilities to steal credentials for thousands of TP-Link routers worldwide. The actors then accessed many of these compromised routers without authorization and manipulated their settings to redirect DNS requests to GRU-controlled servers – i.e., malicious DNS resolvers. GRU actors were indiscriminate in their initial targeting and manipulation of routers. The actors then implemented an automated filtering process to determine which DNS requests were of interest and warranted interception. For select targets, the GRU’s DNS resolvers provided fraudulent DNS records for specific domains that mimicked legitimate services – including Microsoft Outlook Web Access – to facilitate Actor-in-the-Middle attacks against encrypted victim network traffic. In doing so, the GRU actors harvested unencrypted passwords, authentication tokens, emails, and other sensitive information from devices on the same network as the compromised TP-Link routers.

“The GRU’s predatory use of networks in American homes and businesses for its malicious cyber operations remains a serious and persistent threat,” said Assistant Attorney General for National Security John A. Eisenberg. “NSD will continue to use every tool at our disposal to detect such intrusions and expel hostile foreign actors from our Nation’s networks.”

“Russian military intelligence once again hijacked Americans’ hardware to commandeer critical data,” said U.S. Attorney David Metcalf for the Eastern District of Pennsylvania. “In the face of continued aggression by our nation-state adversaries, the U.S. government will respond just as aggressively. Working with the FBI — and our partners around the world — we are committed to disrupting and exposing such threats to our nation’s cybersecurity.”

“Operation Masquerade demonstrates the FBI’s commitment to identifying, exposing, and disrupting the Russian government’s efforts to compromise American devices, steal sensitive information, and target critical infrastructure,” said Assistant Director Brett Leatherman of FBI’s Cyber Division. “GRU actors compromised routers in the US and around the world, hijacking them to conduct espionage. Given the scale of this threat, sounding the alarm wasn’t enough. The FBI conducted a court-authorized operation to harden compromised routers across the United States. We urge all router owners to take the remediation steps outlined today, because defending our networks requires all of us. The FBI will continue to use its authorities to identify and impose costs on state-sponsored actors who target the American people.”

“Operation Masquerade – led by FBI Boston – is the latest example of how we’re defending our homeland from Russia’s GRU which weaponized routers owned by unsuspecting Americans in more than 23 states to steal sensitive government, military, and critical infrastructure information,” said Special Agent in Charge Ted E. Docks of the FBI’s Boston Field Office. “The FBI utilized cutting edge technology and leveraged our private sector and international partners to unmask this malicious activity and remediate routers. Now we’re asking everyone who has a router to secure it, update its firmware, and replace it if needed. By working together, we can guard against nefarious nation state actors trying to compromise our national security.”

As described in court documents unsealed in the Eastern District of Pennsylvania, the FBI developed a series of commands to send to compromised routers in the United States, designed to collect evidence regarding the GRU actors’ activity, reset DNS settings (i.e., remove GRU DNS resolvers and force routers to obtain legitimate DNS resolvers from their Internet Service Providers (ISP)), and to otherwise prevent the GRU actors from exploiting the original means of unauthorized access.

As described in court documents, the government extensively tested the operation on firmware and hardware for affected TP-Link routers. Other than stymieing the GRU’s ability to access the routers, the operation did not impact the routers’ normal functionality or collect the legitimate users’ content information.

The court-authorized steps to remediate compromised routers can be reversed by legitimate users at any time through factory resets with hardware reset buttons. Legitimate users can also reverse changes by logging into web management pages and restoring desired settings (e.g., factory default settings).

To better protect themselves, all users of SOHO devices are encouraged to conduct the following remediation steps:

1. Replace End-of-Life and End-of-Support routers;
2. Upgrade to the latest available firmware;
3. Verify the authenticity of DNS resolvers listed in router settings; and
4. Review and implement firewall rules to prevent the unwanted exposure of remote management services.

Users are encouraged to navigate to the official TP-Link website and review documentation for their affected routers in the download center to learn more about proper configurations. Users should also ensure their routers are operating the latest firmware and review the End-of-Life product lists to determine if their routers should be replaced. Additional remediation guidance is provided in a separate PSA.

The FBI is working with ISPs to provide notice of the operation to users of SOHO routers covered by the court’s authorization. If you believe you have a compromised router, please contact your local FBI field office or file a report with the FBI’s Internet Crime Complaint Center.

The FBI Boston and Philadelphia Field Offices and Cyber Division, U.S. Attorney’s Office for the Eastern District of Pennsylvania, and the National Security Division’s National Security Cyber Section led the disruption effort. Black Lotus Labs® at Lumen and Microsoft Threat Intelligence provided valuable technical contributions to this announcement. MIT Lincoln Laboratory provided valuable assistance with testing and validation.

Source: United States Department of Justice Criminal Division

NEW ORLEANS, LOUISIANA – LIKE CHEN, age 36, pled guilty on April 1, 2026, before United States District Judge Greg G. Guidry to conspiracy to distribute, and possess with intent to distribute, a mixture and substance containing one hundred (100) kilograms or more of a detectable amount of marijuana, in violation of Title 21, United States Code, Sections 841(a)(1), 841(b)(1)(B), and 846, announced U.S. Attorney David I. Courcelle.  

Source: United States Department of Justice Criminal Division

The Justice Department announced today three separate civil and criminal actions to hold two companies and two individual defendants accountable for schemes that attempted to fraudulently bill taxpayer-funded programs of over $500 million.

Department of Justice efforts support President Trump’s Task Force to Eliminate Fraud, a whole-of-government effort chaired by Vice President J.D. Vance to eliminate fraud, waste, and abuse within Federal benefit programs.

“Thanks to the leadership of President Donald Trump, the Department, working closely with the Task Force to Eliminate Fraud, is supercharging efforts to take down every fraudster and bring them to justice,” said Acting Attorney General Todd Blanche. “In one day, the Department prosecuted the theft of a half-billion in taxpayer dollars. All those ripping off the American people are on notice.”

National Partnership of Insurance Brokers and its Former Subsidiary Agree to Pay Over $160 Million For Affordable Care Act Enrollment Fraud Scheme

AP of South Florida, LLC (APSF), an insurance brokerage company headquartered in Florida, has agreed to plead guilty for its role in an Affordable Care Act (ACA) enrollment fraud scheme. APSF, through its highest-ranking executives, preyed on thousands of vulnerable consumers to fraudulently enroll them into fully subsidized ACA plans, for which the federal government awarded $141.5 million in unwarranted subsidies. In a parallel civil resolution, AssuredPartners, Inc., a national partnership of insurance brokers and the then-parent company of APSF, agreed to pay $135 million to resolve allegations that it violated the False Claims Act by submitting fraudulent ACA health insurance plan applications. AssuredPartners, Inc., is not charged in the criminal information.

The Criminal Case

The federal government offers subsidies to help eligible beneficiaries pay for health insurance plans. These subsidies are offered as tax credits to beneficiaries or as payments to insurers as Advanced Premium Tax Credits (APTCs). APTCs are paid directly to insurance plans by the federal government in the form of a payment toward the beneficiary’s applicable monthly premium.

A criminal information was filed yesterday charging APSF with one count of major fraud against the United States. APSF has agreed to resolve the criminal charge by pleading guilty and paying restitution of $27.6 million. As part of its plea agreement, APSF admitted that, through certain of its executives and employees, APSF knowingly and intentionally defrauded the federal government. According to court documents, APSF targeted vulnerable, low-income individuals experiencing homelessness, unemployment, and mental health and substance abuse disorders, and, through “street marketers” working on APSF’s behalf, sometimes offered cash and gift cards to induce those individuals to enroll in subsidized ACA plans. APSF enrolled these vulnerable 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. As a result of being enrolled in subsidized ACA plans for which they did not qualify, some of these consumers experienced serious disruptions in their medical care or prior insurance coverage under Medicaid or other programs. Some consumers who APSF fraudulently enrolled into fully subsidized ACA plans lost access to free health benefits through Medicaid or local assistance programs, and as a result, these consumers faced increased costs in accessing HIV medication, medication to treat opioid dependence and medication to treat mental health disorders. At times, consumers faced unaffordable co-pays and other costs because APSF enrolled these consumers in plans without regard to the consumers’ medical needs, the availability of other programs (including Medicaid and local assistance programs) and the consumers’ ability to pay out-of-pocket costs.

FBI, HHS-OIG and IRS-CI are investigating the criminal case.

The Civil Case

The False Claims Act settlement resolves allegations that, from February 2021 through September 2022, APSF knowingly submitted false or fraudulent applications for subsidized ACA plans on behalf of thousands of consumers in order to obtain commissions and bonus payments from insurers. APSF contracted with “street marketers” who targeted homeless shelters, bus stops, drug treatment clinics and similar locations. The marketers offered incentives, such as cash or gift cards, to individuals to enroll in subsidized ACA plans or to provide their personal information so that APSF could submit applications on their behalf. APSF employees then submitted applications falsely representing that the consumers would make a minimum income amount just over the federal poverty line in order to cause the government to pay the highest subsidy amount.

APSF employees also knowingly submitted false information to Florida’s Medicaid program in order to generate letters stating that the applicant was denied Medicaid coverage and then used these letters as a qualifying event to trigger a Special Enrollment Period, which allowed APSF to submit applications for ACA plans outside of the normal enrollment periods. APSF employees also evaded the federal government’s attempts to verify information in consumers’ ACA applications by submitting false information in response to inquiries from the Centers for Medicare and Medicaid Services when it sought to verify the false information (including income information) submitted by APSF. Some consumers experienced disruptions in their medical care as a result of being enrolled by APSF in subsidized ACA plans that did not provide coverage for their medical needs. APSF received commissions, bonuses, and/or other payments for consumers it enrolled in ACA plans, and a significant portion of APSF’s revenues from these fraudulently obtained payments flowed up to its then-parent corporation, AssuredPartners.

The settlement resolves allegations originally brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act, which allow private parties to bring suit on behalf of the government and to share in any recovery. The whistleblower will receive $24.3 million as their share of the recovery in this case.

The claims resolved by the civil settlement are allegations only and there has been no determination of liability in the civil settlement.

California Man Pleads Guilty to Orchestrating $270M Medication Reimbursement Fraud Scheme

A California man pleaded guilty yesterday to submitting nearly $270 million in fraudulent claims over an 11-month span to California’s Medicaid program (Medi-Cal) for expensive prescription drugs that were medically unnecessary and, in many instances, not provided to the purported recipients.

According to court documents, Paul Randall, 66, of Orange, along with pharmacist and pharmacy owner Kyrollos Mekail, 37, of Moreno Valley, and nurse practitioner Patricia Anderson, 58, of West Hills, exploited Medi-Cal’s suspension of its requirement that health care providers obtain prior authorization before providing certain medications at the beginning of 2022.  Medi-Cal temporarily suspended the requirement as part of a transition to a new payment system. Using a business called Monte Vista Pharmacy, which Mekail owned, Randall and his co-schemers billed Medi-Cal tens of millions of dollars per month for purportedly dispensing high-reimbursement drugs containing cheap, generic ingredients that were manufactured in unique dosages, combinations or package quantities and were not included in the applicable maximum price lists that cap Medi-Cal reimbursements.

In furtherance of the scheme, Randall paid illegal kickbacks to patient marketers in exchange for Medi-Cal beneficiary information and thereafter paid illegal kickbacks to Anderson to sign pre-filled prescriptions for 19 high-reimbursement, non-contracted, generic drugs. Anderson never met the patients, reviewed their medical records or otherwise determined that the medications were medically necessary before signing the prescriptions. The medications, which included pain creams and Folite tablets, a vitamin available over the counter, were billed for thousands of dollars each, including approximately $13,424 for one prescription of meloxicam 5 mg, a generic drug that typically costs between $5 and $25 for a 30-day supply in larger dosages.

Randall received a portion of Monte Vista’s reimbursements from Medi-Cal, at times equaling approximately 40% of Monte Vista’s profit from the false and fraudulent claims. Randall admitted in his plea agreement that he caused at least $269,120,829 in false and fraudulent claims to Medi-Cal from May 2022 to April 2023, of which Medi-Cal paid at least approximately $178,746,556. Randall also admitted that he committed the offense while on release in another criminal case.

Randall and others laundered their illicit proceeds by transferring the money to a third party to pay kickbacks to Anderson in an attempt to conceal the crime from law enforcement.

In his plea agreement, Randall agreed to forfeit property obtained from the fraud, including bank account balances exceeding $17 million, three vehicles, seven real properties, and sports memorabilia. To date, the government has seized approximately $126.5 million in assets that Randall and his co-schemers accumulated from the scheme, including $111 million in bank funds and securities, nine luxury vehicles totaling approximately $1 million, nine luxury real properties totaling approximately $13.5 million, and more than $1 million worth of sports memorabilia.

Randall pleaded guilty to one count of wire fraud. He faces a maximum penalty of 30 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Relatedly, in August 2024, Mekail pleaded guilty to two counts of health care fraud and awaits sentencing. In April 2025, Anderson pleaded guilty to two counts of health care fraud and also awaits sentencing.

The FBI, HHS-OIG, and the California Department of Justice are investigating the case.

Business Owner Sentenced to Over Four Years in Prison for $100M COVID-19 Tax Credit Scheme

A Nevada woman was sentenced yesterday to 54 months in prison and three years of supervised release for conspiring to defraud the United States by fraudulently claiming nearly $100 million in COVID-19 related employment tax credits.

According to court documents and statements made in court, Candies Goode-McCoy, formerly of Las Vegas, conspired with others to file tax returns seeking fraudulent refunds based on the employee retention credit and paid sick and family leave credit, credits which Congress created to aid struggling businesses during the COVID-19 global pandemic. From approximately June 2022 through September 2023, McCoy filed more than 1,200 tax returns for her own businesses and those of others, which falsely claimed these credits and sought refunds totaling more than $98 million.

In total, the IRS paid out approximately $33 million as a result of the scheme. Personally, Goode-McCoy received over $1.3 million in fraudulent refunds. She also received approximately $800,000 from clients for filing fraudulent returns. McCoy used the proceeds to pay for vacations, luxury cars and other luxury goods, and to gamble at casinos.

Goode-McCoy pleaded guilty to one count of conspiracy to defraud the government with respect to claims. In addition to the term of imprisonment, McCoy was ordered to pay the IRS $26,022,188 in restitution.

IRS Criminal Investigation and the Treasury Inspector General for Tax Administration investigated the case.

Source: United States Department of Justice Criminal Division

MACON, Ga. – A Jamaican man who illegally reentered the U.S. after a federal conviction and stole another’s identity to remain in the country now faces up to ten years in prison following a U.S. Department of State investigation. Roan Lynch, 54, a citizen of Jamaica and a resident of Forsyth, Georgia, pleaded guilty to one count of making a false statement in an application for a passport, one count of aggravated identity theft and one count of illegal reentry before U.S. District Judge Marc Treadwell on April 6. Lynch faces a maximum sentence of ten years in prison for the false statement in an application for a passport charge; a maximum sentence of two years in prison for the illegal reentry charge; a mandatory consecutive two-year prison sentence for the aggravated identity theft charge; and a $250,000 fine per count. Sentencing is scheduled for July 9. There is no parole in the federal system.