Troy Health, Inc. Admits to Medicare Fraud and Identity Theft Scheme
A North Carolina-based provider of Medicare Advantage, Medicare Part D, and Dual Eligible Special Needs Plans, Troy Health, Inc., has entered into a non-prosecution agreement with the government to resolve a criminal investigation into a health care fraud and identity theft scheme.
According to the government, Troy Health, Inc. misused patient data to enroll beneficiaries in its Medicare Advantage plan without their consent. The company also used an artificial intelligence-based health care management platform to lower the cost of care and improve health outcomes, but instead misused the platform by offering pharmacies kickbacks for enrollment referrals.
The scheme involved the use of proprietary software developed by one of Troy’s executives to unlawfully access pharmacy records and customer lists containing sensitive personal information. Troy used that information to make unsolicited sales calls to potential beneficiaries and provided false and misleading information to Medicare beneficiaries.
Troy admitted that, from approximately October 2020 through the end of 2022, it defrauded the Medicare program by enrolling beneficiaries in Troy’s Medicare Advantage plans without their knowledge or consent. At the height of the scheme, during the Medicare Advantage open enrollment period between Jan. 1, 2022 and March 31, 2022, Troy enrolled over 2,700 new Medicare beneficiaries.
Under the terms of the non-prosecution agreement, Troy has agreed to cooperate with the government’s ongoing investigation and has admitted to the criminal charges. The company has also agreed to pay a fine and has taken steps to rectify the harm caused by its actions.
Troy Health, Inc. is a North Carolina-based provider of Medicare Advantage, Medicare Part D, and Dual Eligible Special Needs Plans. The company’s headquarters is located in [city], North Carolina.
Criminal Charges: Health care fraud and identity theft
City and State: [city], North Carolina
Exact Date: October 2020 – December 2022
Sentence or Outcome: Non-prosecution agreement, fine, and cooperation with the government’s ongoing investigation.
Key Facts
- State: North Carolina
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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