Louisiana Couple and Their Business Plead Guilty to Operating Sham Medical Reimbursement Account Program that Defrauded the IRS and Program Participants Out of Over $48 Million
A Covington, Louisiana, couple and their company pleaded guilty for their roles in a scheme to create, market and operate a fraudulent medical reimbursement program that defrauded the IRS and program participants out of over $48 million.
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Peter G. Strasser of the Eastern District of Louisiana, Special Agent in Charge Thomas J. Holloman of the Internal Revenue Service Criminal Investigation’s (IRS-CI) Atlanta Field Office, Special Agent in Charge Eric J. Rommal of the FBI’s New Orleans Field Office, Special Agent in Charge Steve Grell of the U.S. Department of Labor, Office of Inspector General’s (DOL-OIG) Dallas Regional Office and Regional Director James Purcell of the U.S. Department of Labor, Employee Benefits Security Administration’s Kansas City Regional Office made the announcement.
Denis Joachim, 53, pleaded guilty to one count of conspiracy to commit money laundering; Donna Joachim, 52, pleaded guilty to one count of conspiracy to defraud the United States; and The Total Financial Group, Inc. (TTFG) pleaded guilty to one count of conspiracy to make false statements and representations in connection with a multiple employer welfare arrangement and five counts of making false statements and representations in connection with a multiple employer welfare arrangement. All the pleas took place before U.S. District Judge Carl J. Barbier of the Eastern District of Louisiana on May 30, 2019, and were unsealed yesterday. Sentencings have been scheduled for Sept. 5, 2019, before Judge Barbier. As part of their guilty pleas, the defendants have agreed to forfeit assets previously seized with a collective value of approximately $6.3 million. Additionally, the defendants acknowledged a potential loss to the victims totaling more than $48 million and agreed to repay restitution for the amount of loss.
According to admissions made as part of the guilty pleas, TTFG was a Louisiana business incorporated by Denis Joachim and Donna Joachim with the Louisiana Secretary of State that was most recently located at 406 N. Florida Street in Covington. TTFG and its owners created and marketed a medical reimbursement account program called “Classic 105,” which operated from about 2012 until January 2017. Classic 105 claimed to be a multiple employer welfare arrangement that was marketed to employers as a supplemental benefits plan for their employees to reimburse for medical expenses such as co-pays and deductibles; participants in Classic 105 were required to have a primary health insurance plan unrelated to and in addition to Classic 105.
This case was investigated by the IRS-CI, the FBI, the DOL-OIG and the Employee Benefits Security Administration. Assistant U.S. Attorneys Jordan Ginsberg and Maria Carboni of the Eastern District of Louisiana and Trial Attorney Jared Hasten of the Criminal Division’s Fraud Section are prosecuting the case. Senior Trial Attorney Rebecca Pyne of the Criminal Division’s Organized Crime and Gang Section, Labor-Management Racketeering Unit also provided assistance with the prosecution.
The Medicare Fraud Strike Force is part of a joint initiative between the Department of Justice and U.S. Health and Human Services (HHS) to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.