Father/son fraudsters busted for #ACA insurance scam

Answer: When you start seeing consumer fraud stories in the vein of Rick Scott's 1990's Medicare fraud scam.

Via Kelsey Waddill of Health Payer Intelligence:

March 02, 2021 - In a nationwide case, two individuals have been found guilty of an Affordable Care Act enrollment fraud scheme that used individuals in need of substance abuse care and falsely enrolled them in Affordable Care Act plans, the Department of Justice (DOJ) announced.

The defendants, Jeffrey White and Nicholas White who are father and son respectively, sought to enroll individuals in Affordable Care Act plans in states other than their own, specifically states that had high reimbursement rates for substance abuse treatment.

The two men went so far as to create fake residential addresses and cell phone numbers with accurate area codes that would direct the call to the Whites’ phones.

“In order to enroll the individuals in an ACA plan, the Whites paid the insurance premiums for the individuals, and also paid to have the individuals transported to California where the individuals were placed in expensive residential substance abuse treatment programs,” the DOJ explained.

Once the individuals were in these California-based substance abuse care centers, the centers would rack up high costs for these individuals’ care, which they would charge to the Affordable Care Act plans.

The Whites received compensation for each referral to these treatment centers and sometimes an additional share of the reimbursement funds that treatment programs received from Affordable Care Act health plans.

...The Whites’ income from both the referral compensation and the kickback shares amounted to approximately $1 million.