Category: MIL-OSI

Source: United States Department of Justice

NFDC Opens with Widespread Collaboration with Inspectors General and Law Enforcement Agencies

Source: United States Department of Justice Criminal Division

Anthony Bernard Coles, of Clarksburg, West Virginia, was sentenced today to 292 months in federal prison for trafficking dangerous drugs, announced U.S. Attorney Matthew L. Harvey. Coles, also known as “Pay Day,” and “Him Him,” 39, sold methamphetamine and cocaine on multiple occasions in Harrison County.

Source: United States Department of Justice Criminal Division

UTICA, NEW YORK – Reginaldo Nunes Dos Santos, 49, of Brazil, pled guilty Tuesday, July 28, to one count of illegal reentry into the United States.  First Assistant United States Attorney John A. Sarcone III and James P. D’Amato, Acting Chief Patrol Agent, U.S. Border Patrol Buffalo Sector made the announcement.

Source: United States Department of Justice Criminal Division

SYRACUSE, NEW YORK – Wenjian Zhuo, age 32, a Chinese national and lawful permanent resident of the United States, was sentenced July 28, 2026, to 27 months in prison for possessing a controlled substance with intent to distribute it. Zhuo was convicted by a jury after a two-day trial in federal court in Syracuse in February.  

Source: United States Department of Justice Criminal Division

AiNET Corp. and its former Chief Executive Officer Deepak Jain have agreed to pay $1,800,000 to resolve allegations that they violated the False Claims Act by knowingly submitting false claims for data center services provided under a contract with the U.S. Securities and Exchange Commission (SEC). AiNET operates a data center in Beltsville, Maryland.

“Those who do business with the government must do so fairly and honestly,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “We will continue to pursue contractors that knowingly fail to provide required services to federal agencies.”

“Protecting taxpayer dollars is an OIG priority,” said SEC Inspector General Kevin Muhlendorf. “The SEC OIG’s dedicated team of investigators and auditors works tirelessly to hold contractors accountable, and we appreciate our continued partnership with the Department of Justice in that shared endeavor.”

The settlement resolves allegations that AiNET and Deepak Jain fraudulently induced the SEC to enter the contract by falsely certifying that the AiNET data center met at least Tier III standards as defined by the Telecommunications Industry Association (TIA) Standards for Data Centers, TIA 942, and as required by the SEC contract. The United States alleged that the AiNET data center failed to comply with Tier III standards and that AiNet and Jain falsely certified to the SEC that experts from an entity called UpTime Council had inspected the data center and determined it was Tier IV, as defined by TIA 942. The United States alleged that these certifications were false because UpTime Council was not an operating company and never inspected the AiNET data center.

This year the Administration launched the Task Force to Eliminate Fraud and the National Fraud Enforcement Division to enhance the Administration’s war on fraud, waste, and abuse in federal programs. When unscrupulous actors exploit these programs for their own financial gain, they defraud the government, harm the people these programs are designed to aid and protect, and undermine American businesses that play by the rules. The Civil Division’s FCA enforcement plays a critical role in combatting such fraudulent schemes, recovering billions of dollars for the American taxpayers, and holding wrongdoers accountable. FCA matters will continue to be on the forefront of the battle against fraud, and the Civil Division’s FCA work will support and advance the mission of the Task Force to Eliminate Fraud and the National Fraud Enforcement Division.

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 SEC, Office of the Inspector General. Senior Trial Attorney Greg Pearson of the Fraud Section handled the matter.

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

Monogram Health Professional Services PC and Monogram Health Inc., headquartered in Tennessee, have agreed to pay $2.4 million to resolve allegations that they violated the False Claims Act by causing the submission of false diagnosis codes in order to increase payments that they received from the Medicare Advantage program.

Source: United States Department of Justice Criminal Division

Monogram Health Professional Services PC and Monogram Health Inc., (Monogram Health), headquartered in Tennessee, have agreed to pay $2.4 million to resolve allegations that they violated the False Claims Act by causing the submission of false diagnosis codes in order to increase payments that they received from the Medicare Advantage program.

“When companies submit false diagnosis codes, they unlawfully exploit a system built to support vulnerable seniors,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “This settlement reinforces the Department’s commitment to protecting taxpayer money and ensuring that Medicare Advantage payments are based on accurate information.”

“When it comes to how federal money is being spent, taxpayers deserve to know that this Justice Department is looking out for them,” said First Assistant U.S. Attorney Bill Essayli for the Central District of California. “My office will continue to work to ensure that money for public health programs is spent how it’s intended, as today’s settlement shows.”

“Health care companies that seek to inflate profits by inaccurately reporting the medical conditions of Medicare Advantage enrollees will be held accountable,” said Acting Deputy Inspector General for Investigations Miranda L. Bennett of the Department of Health and Human Services Office of Inspector General (HHS‑OIG). “This settlement underscores HHS‑OIG’s commitment to protecting the integrity of taxpayer‑funded federal health care programs. Medicare Advantage exists to deliver medically necessary care to beneficiaries, not to serve as a vehicle for improper financial gain.”

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 calculate the payment amounts, CMS uses a health-based risk adjustment model — the Hierarchical Conditions Category (HCC) model — that takes into account diagnoses reported by healthcare providers.

In general, the more severe the diagnosis or costly the associated treatment, the higher the risk score and the higher the corresponding payments to the MAO. 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.

Monogram provides in-home care and related services to Medicare beneficiaries enrolled in MA Plans pursuant to contracts with certain MAOs. Under these contracts, Monogram was eligible to be paid more by the MAOs if the beneficiaries in its care had higher risk scores because the MAO received higher payments from CMS for those beneficiaries.  These risk sharing arrangements gave Monogram a financial incentive to submit additional diagnosis codes in order to increase its patients’ risk scores and the corresponding payments made by CMS.

The settlement announced today resolves allegations that, during the period from Jan, 1, 2021 through Dec. 31, 2023, Monogram knowingly submitted diagnosis codes within the following four HCCs that were not clinically accurate, not supported by documentation in the beneficiary’s medical records, and/or did not require or affect patient care, treatment or management: HCC 21 (Protein-Calorie Malnutrition), HCC 55 (Substance Use Disorder); HCC 48 (Coagulation Defects and Other Specified Hematological Disorders), and HCC 88 (Angina Pectoris). The submission of these diagnosis codes resulted in false claims that inflated the risk scores of the Medicare Advantage beneficiaries, thereby causing CMS to make higher capitated payments to the MAOs than it would have paid without these diagnosis codes.

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Dr. Ajay Gupta, a physician formerly employed by Monogram. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Dr. Gupta will receive approximately $380,000 as his share of the recovery in this case. The lawsuit is captioned U.S. ex rel. Dr. Ajay Gupta v. Monogram Health Professional Services, et. al., Case No. 2:22-cv-08758 MWF-JCx (C.D. Cal.).

This year the Administration launched the Task Force to Eliminate Fraud and the National Fraud Enforcement Division to enhance the administration’s war on fraud, waste, and abuse in federal programs. When unscrupulous actors exploit these programs for their own financial gain, they defraud the government, harm the people these programs are designed to aid and protect, and undermine American businesses that play by the rules. The Civil Division’s FCA enforcement plays a critical role in combatting such fraudulent schemes, recovering billions of dollars for the American taxpayers, and holding wrongdoers accountable. FCA matters will continue to be on the forefront of the battle against fraud, and the Civil Division’s FCA work will support and advance the mission of the Task Force to Eliminate Fraud and the National Fraud Enforcement Division.

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. Attorney’s Office for the Central District of California with assistance from the U.S. Department of Health and Human Services Office of Inspector General.  

The investigation and resolution of this matter illustrate the government’s emphasis on combating health care 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 matter was investigated by Fraud Section Attorney Jennifer Cook and Assistant U.S. Attorney Hunter B. Thomson for the Central District of California.

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

United States Attorney Ron Parsons announced that a jury has convicted Clayton High Wolf, Jr., age 41, of Pine Ridge, South Dakota, of Conspiracy to Distribute a Controlled Substance following a three-day jury trial in federal district court in Rapid City, South Dakota.  The verdict was returned on August 20, 2026.

Source: United States Department of Justice Criminal Division

Juan Manuel Gouveia-Aguilera, 27, originally of Venezuela, was sentenced on August 20, 2026, in federal court in Omaha, Nebraska, for his role in a conspiracy to deploy malware and steal millions of dollars from ATMs in the United States, a crime commonly referred to as “ATM jackpotting.”