Threat actors behind Medicare and Medicaid fraud schemes face charges

Ten individuals are charged for their role in money laundering and wire fraud schemes targeting US state and private healthcare programs, which cost victims more than $11.1 million in total losses, the US Department of Justice announced.

The defendants are accused of posing as business partners to convince victims they are making legitimate payments by using spoofed email addresses, bank account takeovers, and similar fraudulent methods. They also allegedly participated in elderly romance scams, deceiving them into sending hundreds of thousands of dollars.

In fact, the made payments were redirected to accounts of threat actors.

“In the District of South Carolina, we’ve seen a marked increase in email scams, identity theft, and related money laundering schemes,” said U.S. Attorney Adair Boroughs for the District of South Carolina.

As such, the individuals are accused of diverting payments meant to cover medical services. They would send out fraudulent emails from accounts resembling legitimate hospitals to public and private health insurance programs, asking to change bank account details for all future reimbursements.

Among those who fell victim were five state Medicaid programs, two Medicare Administrative Contractors, and two private health insurers. This amounted to over $4.7 million in losses for said companies, and $6.4 million in losses to other federal government agencies, private companies, and individuals.

“These defendants defrauded numerous individuals, companies, and federal programs, resulting in millions of dollars in financial losses to vital federal programs meant to provide assistance to those in need,” said U.S. Attorney Ryan K. Buchanan for the Northern District of Georgia.

Threat actors would then launder the money by withdrawing large amounts of cash, transferring them overseas, purchasing luxury goods and exotic automobiles, or layering them through accounts opened in fake or stolen names.

All ten defendants come from different states: eight from Georgia, one from South Carolina, and one from Virginia. Most face a maximum of 20 years of prison, with two individuals facing a maximum of 30 years.

“Millions of American citizens rely on Medicaid, Medicare, and other health care systems for their health care needs. These subjects utilized complex financial schemes, such as BECs and money laundering, to defraud and undermine health care systems across the United States,” said Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division. “Elder fraud and romance fraud schemes utilized by the subjects often target our most vulnerable citizens and the FBI is committed to pursuing justice for those who were victimized by these schemes.”