Category: Security

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United States Files Complaint Against Several National Health Insurance Companies and Brokers Alleging Unlawful Kickbacks and Discrimination Against Disabled Americans

Source: US FBI

Government alleges that three of the nation’s largest health insurance companies paid hundreds of millions of dollars in illegal kickbacks in exchange for Medicare Advantage enrollments

BOSTON – The United States has filed a complaint against three of the nation’s largest health insurance companies: Aetna, Inc. and affiliates; Elevance Health, Inc. (formerly known as Anthem); and Humana Inc., and three large insurance broker organizations: eHealth, Inc. and an affiliate; GoHealth, Inc.; and SelectQuote, Inc. The United States alleges that from at least 2016 through at least 2021, the defendant insurers paid hundreds of millions of dollars in illegal kickbacks to the defendant brokers in exchange for enrollments into the insurers’ Medicare Advantage plans.

Under the Medicare Advantage (MA) Program, also known as Medicare Part C, Medicare beneficiaries may choose to enroll in health care plans (MA plans) offered by private insurance companies, such as defendants Aetna, Anthem and Humana. Many Medicare beneficiaries rely on insurance brokers to help them choose an MA plan that best meets their individual needs. Rather than acting as unbiased stewards, the defendant brokers allegedly directed Medicare beneficiaries to plans offered by insurers that paid brokers the most in kickbacks, regardless of the suitability for the beneficiary. According to the complaint, the broker organizations incentivized their employees and agents to sell plans based on the insurers’ kickbacks, set up teams of insurance agents who could sell only those plans, and at times refused to sell MA plans of insurers who did not pay sufficient kickbacks.  

The United States further alleges that Aetna and Humana each conspired with the broker defendants to discriminate against Medicare beneficiaries with disabilities whom they perceived to be less profitable. Aetna and Humana did so by allegedly threatening to withhold kickbacks to pressure brokers to enroll fewer disabled Medicare beneficiaries in their plans. The United States alleges that, in response to these financial incentives from Aetna and Humana, the defendant brokers, or their agents, rejected referrals of disabled beneficiaries and strategically directed disabled beneficiaries away from Aetna and Humana plans.

“It is concerning, to say the least, that Medicare beneficiaries were allegedly steered towards plans that were not necessarily in their best interest – but rather in the best interest of the health insurance companies. The alleged efforts to drive beneficiaries away specifically because their disabilities might make them less profitable to health insurance companies are even more unconscionable. Profit and greed over beneficiary interest is something we will continue to investigate and prosecute aggressively,” said United States Attorney Leah B. Foley. “This office will continue to take decisive action to protect the rights of Medicare beneficiaries and vulnerable Americans.”

“Health care companies that attempt to profit from kickbacks will be held accountable,” said Deputy Assistant Attorney General Michael Granston of the Justice Department’s Civil Division. “We are committed to rooting out illegal practices by Medicare Advantage insurers and insurance brokers that undermine the interests of federal health care programs and the patients they serve.”

The lawsuit was originally filed under the qui tam or whistleblower provisions of the False Claims Act (FCA). Under the FCA, private parties can file an action on behalf of the United States and receive a portion of the recovery. The FCA permits the United States to intervene in and take over the action, as it has done here. If a defendant is found liable for violating the FCA, the United States may recover three times the amount of its losses plus applicable penalties.

U.S. Attorney Foley and AAG Granston made the announcement today. Valuable assistance was provided by the Department of Health and Human Services, Office of the Inspector General and the Federal Bureau of Investigation. Assistant U.S. Attorneys Charles B. Weinograd and Julien M. Mundele of the Affirmative Civil Enforcement Unit are handling the matter along with Trial Attorneys David G. Miller, Anna H. Jugo, Diana E. Curtis and Sara B. Hanson of the Justice Department’s Civil Division.

The claims asserted in the complaint are allegations only. There has been no determination of liability.

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Fausto Isidro Meza-Flores Added to FBI’s Ten Most Wanted Fugitives List

Source: US FBI

Meza-Flores was originally indicted on May 2, 2012, in the U.S. District Court for the District of Columbia. On November 26, 2019, a federal grand jury returned a superseding indictment charging Meza-Flores with drug trafficking violations and possession of a firearm. According to the indictment, Meza-Flores allegedly conspired to manufacture and distribute cocaine, heroin, methamphetamine, and marijuana in the U.S. from 2005 to 2019.   

Meza-Flores is 42 years old and has dark brown hair and brown eyes. He is 5’6″ tall and weighs about 160 pounds. He also goes by the nicknames “Chapo Isidro” and “Chapito Isidro.”

Meza-Flores is a Mexican national and likely resides in Mexico. He is considered armed and dangerous and is an international flight risk. 

“The U.S. government is offering a reward of up to $5 million for information leading to his arrest and conviction, and we encourage anyone with information about his whereabouts to contact the FBI and help us add Meza-Flores to the list of dangerous fugitives we’ve brought to justice together,” said Acting Director Driscoll.  

If you have any information concerning Meza-Flores, please contact your local FBI office or the nearest American Embassy or Consulate or call the FBI at 1-800-CALL-FBI (1-800-225-5324). You can also submit a tip online at tips.fbi.gov or contact the FBI via WhatsApp at 571-379-3951. WhatsApp is neither a government-operated nor a government-controlled platform. 

This case is also the result of the ongoing efforts by the Organized Crime Drug Enforcement Task Forces (OCDETF), a partnership that brings together the combined expertise and unique abilities of federal, state, and local enforcement agencies. The principal mission of the OCDETF program is to identify, disrupt, dismantle, and prosecute high-level members of drug trafficking, weapons trafficking, and money laundering organizations and enterprises.

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The FBI’s Counterterrorism Division Turns 25

Source: US FBI

A steadfast dedication to countering the threat

After the ISIS caliphate collapsed in the late 2010s, a perception arose that terrorist threats were on a decline. To some, the threat posed by foreign terrorist organizations had diminished to the point where counterterrorism didn’t need to be the Bureau’s top priority.

“And, I’ll admit, I even had my own doubts,” Scott said. “I was a JTTF [Joint Terrorism Task Force] squad supervisor at the time and then assistant special agent in charge at a field office, and I could see that downward trend myself. And it was very obvious. And, of course, I consider that a good thing. If we had helped to diminish the terrorist threat, that’s always a good thing.”

But, he said, the events of October 7, 2023, in the Middle East confirmed the Bureau’s threat calculus.

“Even before the October 7 Hamas attack on Israel, the FBI had been very public in saying that the terrorism threat was already elevated across the board, with international threats, domestic terrorism threats, and the state-sponsored threat,” he said. “And, as I talk to my counterparts now across the interagency—and even with international partners—everybody is saying the same thing: They’re seeing this across the globe. This is an issue that’s not just facing the U.S., but it’s facing everybody with these simultaneously elevated threats.” 

How CTD has evolved 

The Bureau’s bandwidth for handling counterterrorism-related tips has also grown exponentially in the past 25 years, with the creation of our National Threat Operations Center to triage and route tips from the public to investigators in the field.

The FBI’s use of partnerships to stem this threat has expanded in parallel fashion. 

In 1980, the FBI New York Field Office pioneered the Joint Terrorism Task Force partnership model—which brings together experts from local, state, and federal government agencies to leverage their collective range of skillsets to investigate and prevent acts of terror. Since then, these task forces have expanded throughout the field. 

“And, now, you’ve got 4,000 members from over 500 different state and local agencies, 50 federal agencies, all working nationwide on Joint Terrorism Task Forces, and they’re working to prevent any of these domestic attacks, any international terrorism attacks,” Scott said.

The Bureau has also established a Headquarters-level National Joint Terrorism Task Force, whose membership includes representatives from the Defense Department, the U.S. Intelligence Community, and other federal government agencies. The interagency corps coordinates field-level JTTF efforts and oversees personnel movement to ensure those squads have the proper mix of staffing from member agencies, Scott explained.

As for tactics, Scott said the increasing sophistication of terrorists’ techniques and use of communications has also demanded innovation on the part of CTD. For example, he said, these bad actors’ use of encrypted mobile apps to plot attacks against Americans on U.S. soil and around the world inspired the Bureau to form specialized teams, known as Terrorist Use of the Internet squads, to determine how to disrupt such efforts. 

Why the FBI investigates terrorism

Guidelines from the attorney general dictate when the FBI can start a terrorism investigation and authorize the FBI to collect information accordingly. 

This information serves two purposes:

  • First, it helps us build a case against people or groups who break the law to help us arrest them and to assist the U.S. Department of Justice in prosecuting them. Our investigations focus on the unlawful activity of the group, not the ideological orientation or First Amendment-protected activity of its members.
  • Next, it builds an intelligence base that we can analyze to prevent terrorist activity. 

The FBI’s approach to counterterrorism investigations is based on the need both to prevent incidents where possible and to react effectively after incidents occur.

The FBI is empowered to investigate terrorism both at home and overseas. “That goes back to 1983, when Attorney General William French Smith modified the guidelines for conducting intelligence investigations,” Scott said. “And then, the next year, Congress authorized the Bureau to pursue criminals who attacked Americans beyond our shores.”

These days, CTD has a global footprint to protect Americans the world over.

“Now, we have counterterrorism assistant legal attachés––or ALATs––forward-deployed in U.S. embassies across the globe,” Scott said. “We’ve got the fly team that can deploy both domestically and overseas at a moment’s notice. And then, we’ve got a significant portion of our division here at Headquarters that is dedicated to ensuring our U.S. citizens are protected overseas, just as they would be here within the borders of the U.S.” 

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Online Platform Provides Current Data on Law Enforcement Suicides

Source: US FBI

Data includes circumstances surrounding law enforcement suicides and suicide attempts, general locations, demographics, occupations, and the methods used.

“We aim to provide agencies with the means to understand and mitigate situations which could eventually lead to a death by suicide,” said Lora Klingensmith, a program manager in the FBI’s Criminal Justice Information Services (CJIS) Division, which manages the Bureau’s Uniform Crime Reporting (UCR) Program.

This year, according to the LESDC, seven law enforcement agencies have reported nine suicides and three attempted suicides. All the suicide victims were males—seven were white, one was Black, and one was Hispanic or Latino. Firearms were used in seven suicides; two were listed as “other.” The collection does not collect information that identifies individuals.

As with crime statistics, the ideal is to have more agencies report to the LESDC so that a more representative picture emerges. Law enforcement agencies are not required to submit suicide information to the FBI; it’s voluntary. But the Law Enforcement Suicide Data Collection Act, passed in 2020, requires the attorney general and the FBI to report the suicide data annually to Congress. The FBI, which has a nearly century-long history of collecting data from law enforcement agencies, began collecting the information from agencies on January 1, 2022.

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Help the FBI Identify John Doe 49

Source: US FBI

Story Update (December 2, 2024): John Doe 49 has been identified, located, and is in custody.

The FBI is seeking the public’s assistance to identify an unknown male, dubbed John Doe 49, who may possess critical information about a child victim in an ongoing sexual exploitation investigation. 

John Doe 49 is described as a bald, white male between the ages of 45 and 65 years old. He has a dark goatee and at least five visible tattoos: 

  • The word “Dabby” on the right side of his chest 
  • The number “197,” followed by possible additional unknown text, on his left bicep 
  • Additional tattoos on his left and right forearms and right bicep 

We’ve produced a poster featuring still images of John Doe 49 that were taken from a video file.

The source video, which was brought to our attention by our partners at the National Center for Missing and Exploited Children, was produced in July 2024 or earlier. The video file doesn’t include EXIF data. 

No charges have been filed in this case, and John Doe 49 is presumed innocent unless and until proven guilty in a court of law. 

We’re seeking John Doe 49 as part of two FBI initiatives: 

  • Operation Rescue Me, which focuses on using clues obtained through in-depth image analysis to identify child victims shown in child exploitation material 
  • The Endangered Child Alert Program, which seeks to amplify imagery of unknown adults (dubbed John or Jane Does) whose faces or other distinguishing characteristics appear in child sexual exploitation material 

If you recognize and/or have information about John Doe 49, you can submit a tip online at tips.fbi.gov or by calling 1-800-CALL-FBI (1-800-225-5324).

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30-Year-Old Murder Solved

Source: US FBI

The 2012 Latent Hit of the Year Award was presented last month to two employees of the Omaha Police Department—Detective Douglas Herout and Senior Crime Laboratory Technician Laura Casey—for their efforts to identify the man responsible for a brutal murder more than 30 years ago.

The crime: In 1978, 61-year-old Carroll Bonnet was stabbed to death in his apartment. Police collected evidence, including latent fingerprints and palmprints from the victim’s bathroom (officers believed the killer was trying to wash off blood and other evidence before leaving the apartment). The victim’s car was then stolen.

The investigation: The car was found in Illinois, but after collecting additional latent prints, investigators couldn’t develop any new leads. The crime scene evidence was processed, and latent prints recovered from the scene and the car were searched against local and state fingerprint files. Investigators also sent fingerprint requests to agencies outside Nebraska, but no matches were returned and the case soon went cold.

The re-investigation: In late 2008, the Omaha Police Department received an inquiry on the case, prompting technician Laura Casey to search the prints against IAFIS (which didn’t exist in 1978). In less than five hours, IAFIS returned possible candidates for comparison purposes. Casey spent days carefully examining the prints and came up with a positive identification—Jerry Watson, who was serving time in an Illinois prison on burglary charges.

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CJIS Division Observes a Milestone

Source: US FBI

And there was a way. In February 1992, in a memo proposing the creation of a Criminal Justice Information Services Division, a Bureau executive wrote: “The FBI has an opportunity to significantly improve the level of information services provided to the criminal justice community. An all-inclusive CJIS will ensure the needs of our users are met and exceeded well into the 21st century, and the technology advancements gained through the creation of CJIS will ensure that the FBI remains in the forefront of criminal justice information systems worldwide.”

The establishment of this new office—which was, in effect, a one-stop shop for criminal justice information—was quickly approved by the FBI Director.

The CJIS Division initially included the fingerprint identification services from the Identification Division, the UCR Program from the Information Management Division, and the NCIC program from the Technical Services Division. Over the past 25 years, CJIS has successfully overseen the creation of additional criminal justice services to assist our partners. For example:

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Longtime Indian Country Special Agent Reflects on Essential FBI Mission

Source: US FBI

“I love working Indian country,” said Davenport, using the federal government’s designation for Native American lands. “I like catching bad guys. I like the chase. I like helping people. That keeps me going.”

For more than a century, the FBI has had jurisdiction when major crimes are committed against members of federally recognized tribes on reservations. The FBI works alongside the Bureau of Indian Affairs (BIA) and local law enforcement partners working on the reservations.

Davenport supervises a small team of agents and staff in the Pinetop-Lakeside Resident Agency, a satellite office of the Phoenix Division. He said strong working relationships are essential given the remoteness of the work. In Arizona, for example, nearly 25% of the state is designated Indian Country; the Navajo Nation alone occupies more than 15,800 square miles in northern Arizona. Davenport’s office covers the Fort Apache, San Carlos Apache, and Tonto Apache reservations in eastern Arizona.

“It’s a big asset to have tribal police and the Bureau of Indian Affairs working with us,” said Davenport. “There are a lot of things on the reservation that … if you didn’t grow up there, you don’t know.” Tribal police and prosecutors, along with local BIA agents, intimately understand the geography, customs, and people on the reservation.

“They are the eyes and ears,” said Davenport, who grew up about an hour away from the Pinetop-Lakeside office. “I will never know as much about the reservation as tribal police. They live there. They grew up there. They know everybody. They’re a huge asset for us.”

BIA agent Auggie Belvado, an enrolled member of the San Carlos Apache Tribe, said the relationship is symbiotic. He has worked with Davenport and the Bureau’s agents for 16 years and says the different agencies bring unique strengths to bear.

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Operation Not Forgotten Shines New Light on Indian Country Cases

Source: US FBI

“The work this agency does in Indian country territory is among our organization’s highest priorities,” said Michael Rivers, who leads the FBI’s Indian Country and International Violent Crime Unit. “We are proud of and committed to the support and resources we devote to these investigations and the victims. Our hope is that this surge of resources and prioritized action will let people and communities know they are not forgotten.”

Working closely with BIA agents and Tribal police—as well as other federal agencies with responsibilities to serve Tribal communities—is nothing new for the Bureau. The FBI has had jurisdiction over major crimes in Indian country since its earliest days, and it has always relied on partner agencies on reservations, particularly since they know the terrain and the people there better than anyone.

“It’s a big asset to have Tribal police and BIA working with us,” said Special Agent Sam Davenport, who supervises an FBI office in Pinetop-Lakeside, Arizona that borders the Fort Apache Indian Reservation. In the summer of 2023, his office received multiple rotations of agents during the first Operation Not Forgotten. He said they worked closely with the BIA, Tribal police, and local prosecutors to generate leads on cold cases.

Across the country, the FBI has 26 Safe Trails Task Forces made up of federal, state, local and Tribal law enforcement partners. Davenport said having local trusted connections is essential, given the remoteness of most Tribal lands and the established rapport Native American authorities have within their communities.

“They are the eyes and ears,” he said. “They live there. They grew up there. I will never know as much about the reservation as Tribal [police].”

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FBI Personnel Assist in Hurricane Helene Response

Source: US FBI

Special Agents Durant and O’Hare relied heavily on the Mobile Biometrics Application (MBA) and Special Processing Center (SPC) teams to expedite the identification of victims. These specialized units, operating out of the FBI’s Criminal Justice Information Services Division in West Virginia, provided agents in the field with real-time support, often pulling fingerprints and running them through reference files within minutes. In some cases, results were returned in as little as 15 to 20 minutes, streamlining the identification process during critical moments.

The MBA team, in particular, played a vital role by swiftly processing prints, actively monitoring quality control, and troubleshooting more difficult cases. When automated systems didn’t yield a match, the SPC team took over, applying manual processes to assist with identification. This seamless coordination between field agents and the FBI’s lab-based experts highlights the Bureau’s ability to deploy advanced technology in disaster zones, ensuring that victims’ families receive answers as quickly as possible.

While working to bring closure to grieving families, the agents have also felt the storm’s personal impact. O’Hare’s daughter and grandchildren evacuated from North Carolina to stay with her in Upper East Tennessee after being displaced by power loss. “I joined the FBI to help people,” O’Hare said. “In situations like this, that’s why I am doing my very small part to try to provide some closure for the families of the victims.”

As the FBI and its partners work to support communities impacted by Hurricane Helene, the Bureau issued a warning about scammers looking to exploit survivors and mislead charitable donors. Learn to spot the red flags of disaster fraud at fbi.gov/DisasterFraud.