保险经纪公司高管认罪 涉1.339亿美元平价医疗法案补贴诈骗
美国司法部4月18日宣布，佛罗里达州一家保险经纪公司的执行副总裁 Dafud Iza 当日认罪，承认参与提交虚假申请、为不符合资格的人注册由政府全额补贴的《平价医疗法案》保险计划。司法部说，这套手法的目的是从运营这些计划的保险公司骗取数百万美元佣金，联邦政府已为被虚假注册的人支付了至少1.339亿美元补贴。
法庭文件显示，54岁的 Iza 参与把不符合资格的人注册进提供税收抵免的平价医疗法案计划，这些抵免即补贴，可由联邦政府直接付给保险公司充抵月度保费。团伙提交的申请虚报消费者收入，以骗取补贴资格：他们向不符合资格的消费者欺骗性推销补贴计划，并虚增其申报收入。
司法部还说，Iza 与同伙专门针对无家可归、失业以及有心理健康与物质滥用障碍的弱势低收入人群，并明知为他们工作的街头营销人员以行贿诱使这些人注册补贴计划。营销人员教消费者如何回答申请问题，以最大化联邦政府支付的补贴金额，还提供与申请人本人不相符的地址与社会安全号码。
Iza 承认了一项针对美国的重大诈骗罪，最高可判10年监禁，具体量刑将由联邦地区法院法官参照量刑指南等法定因素决定。此案由司法部刑事司司长 Matthew R. Galeotti 与联邦调查局、卫生与公共服务部监察长办公室、国税局刑事调查局的迈阿密办公室负责人共同宣布，三家机构联合调查，刑事司诈骗科的 Jamie de Boer 与 D. Keith Clouser 负责起诉。（来源：美国司法部）
Insurance Brokerage Executive Pleads Guilty in $133.9 Million Affordable Care Act Fraud Scheme
The U.S. Department of Justice announced on April 18 that Dafud Iza, an executive vice president of a Florida insurance brokerage firm, pleaded guilty that day for his role in a scheme to submit fraudulent applications enrolling consumers in Affordable Care Act plans that were fully subsidized by the government. The Justice Department said the purpose of the scheme was to obtain millions of dollars in commission payments from the insurance company that operated the plans, and that the federal government paid at least $133.9 million in subsidies for fraudulently enrolled individuals.
According to court documents, Iza, 54, participated in a scheme to fraudulently enroll ineligible individuals into ACA plans that offered tax credits to eligible enrollees; the credits, or subsidies, could be paid by the federal government directly to insurance plans toward monthly premiums. The scheme involved submitting false and fraudulent applications for individuals whose income did not meet the minimum requirements for the subsidies: Iza and his accomplices deceptively marketed subsidized plans to ineligible consumers and falsely inflated consumers' incomes to obtain the subsidies.
The Justice Department said Iza and his accomplices targeted vulnerable, low-income individuals experiencing homelessness, unemployment, and mental health and substance abuse disorders, and knew that street marketers working on their behalf offered bribes to induce those individuals to enroll. Marketers also coached consumers on how to answer application questions to maximize the subsidy amount and provided addresses and Social Security numbers that did not match the consumers purportedly applying.
Iza pleaded guilty to one count of major fraud against the United States and faces a maximum penalty of 10 years in prison; a federal district judge will determine any sentence after considering the Sentencing Guidelines and other statutory factors. The case was announced by Matthew R. Galeotti, head of the Justice Department's Criminal Division, together with the FBI, the Department of Health and Human Services Office of Inspector General, and IRS Criminal Investigation officials in Miami; the three agencies are investigating the case, and Jamie de Boer and D. Keith Clouser of the Criminal Division's Fraud Section are prosecuting it. (Source: U.S. Department of Justice)
来源：美国司法部
发布：GSM·美国（发布链接）
图片来源：图：位于华盛顿的美国司法部总部罗伯特·F·肯尼迪司法部大楼（资料图）。图：Baseball Watcher，CC BY-SA 3.0，via Wikimedia Commons / Photo: The Robert F. Kennedy Department of Justice Building, headquarters of the U.S. Department of Justice, in Washington, D.C. (file photo). Photo: Baseball Watcher, CC BY-SA 3.0, via Wikimedia Commons
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