Insurance Broker Convicted of $ 3.8 Million Fraud | OPA

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Licensed insurance broker and owner of Benefits Consulting Associates LLC was sentenced to 70 months in prison on Wednesday for participating in the CareFirst BlueCross BlueShield cheating scheme worth over $ 3.8 million.

On November 8, 2019, after a two-week trial, Tarek Abu-Qatwa, aka Dean Addem, 61, from the District of Columbia, was found guilty on one count of healthcare fraud, three counts of false statements related to health issues , seven counts of mail fraud, six counts of electronic fraud and five counts of identity theft in the March 2018 indictment.

According to evidence presented in court, Abu Khatwa was involved in the CareFirst BlueCross Blue Shield fraud scheme, creating fictitious employees and altering the birth years of real employees by as much as 40 years in order to lower the average age of insured groups and fraudulently. get lower insurance premiums. He then inflated the rates he charged on clients and put in a difference that exceeded $ 3.6 million. As part of his scheme, Abu Khatwa also stole the identities of former employees and customers, lowered their age, and transferred them to and from shell companies to fraudulently lower premiums. When Abu Khatwa-controlled groups were screened by CareFirst, he created fake census reports, fake DC wage and tax records, and fake payroll receipts to cover up his fraud.

In addition to his imprisonment, Abu Katwa was sentenced to three years of supervised imprisonment and was paid $ 3,836,709.34 in damages and a penalty of $ 8,402,966.73.

Acting Assistant Attorney General Nicholas L. McQuaid of the Justice Department’s Criminal Division; Acting US Attorney Channing D. Phillips of the District of Columbia; Acting Deputy Director Stephen D’Antuono of the FBI’s Washington Field Office; Responsible Special Agent Maureen Dixon of the Philadelphia Regional Office of the US Department of Health and Human Services (HHS-OIG); and Commissioner Karima Woods of the DC Department of Insurance, Securities, and Banking.

The FBI and HHS-OIG investigated the case with the help of the DC Department of Insurance, Securities and Banking.

Attorney Alexander Kramer of the Criminal Division’s Fraud Division and US Assistant Attorney Ahmed Bazett of the District of Columbia are leading the case. Former Assistant U.S. Attorneys Virginia Cheatham and Derrick Williams from the District of Columbia have previously pursued prosecutions.

The Fraud Division leads the Medicare Fraud Team. Since its inception in March 2007, the Medicare Fraud Team, which includes 15 strike teams operating in 24 counties, has indicted more than 4,200 defendants who have collectively billed Medicare nearly $ 19 billion. In addition, HHS Centers for Medicare and Medicaid Services, working with HHS-OIG, are taking steps to increase accountability and reduce the presence of fraudsters.

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