Troy Health Enters Groundbreaking Non-Prosecution Agreement With DOJ
November 21, 2025 | JacobiJournal.com — Troy Health, a Medicare Advantage provider, recently entered a non-prosecution agreement (NPA) with the U.S. Department of Justice, marking a first-of-its-kind healthcare resolution under the revised Corporate Enforcement Policy (CEP). The DOJ alleges Troy engaged in misconduct, including improper enrollment of Medicare beneficiaries and misuse of personal identifying information facilitated by AI tools. The agreement requires Troy Health to pay approximately $1.4 million and comply with an 18-month NPA, acknowledging its role in a scheme that impacted beneficiaries without their knowledge or consent. How Did Troy Health’s Alleged Fraud Occur? Investigators say Troy’s employees used customer lists from contract pharmacies to enroll beneficiaries into the company’s Medicare Advantage plan. Misleading calls, automated batch enrollments, and AI-driven sales tactics allegedly bypassed proper consent and documentation protocols. Some patients were auto-enrolled in batches of up to 300 at a time, and verification calls were misrepresented as genuine confirmations. The DOJ highlighted that Troy’s AI-enabled platform, Troy.ai, played a central role in orchestrating these enrollment activities. While some pharmacy staff participated, others were unaware that their customer data was being used to enroll individuals without consent. Why This NPA Matters This resolution underscores several critical trends in healthcare fraud enforcement: For healthcare providers and insurers, the case emphasizes the need for robust compliance governance, transparent self-reporting, and proactive auditing of AI-driven systems. How Companies Can Avoid Similar Compliance Pitfalls By proactively addressing these areas, organizations can reduce the risk of enforcement action and protect patient trust. For additional insights into this non-prosecution agreement and healthcare compliance trends, visit: JD Supra – Troy Health NPA. FAQs About Troy Health NPA What is a non-prosecution agreement (NPA)? An NPA is a legal agreement where the government agrees not to prosecute a company for alleged misconduct, provided the company meets certain conditions, such as paying fines or cooperating with investigations. Why did Troy Health enter an NPA with the DOJ? Troy Health admitted to allegations of enrolling Medicare beneficiaries without consent and cooperating partially with the DOJ, making it eligible for an NPA under the revised Corporate Enforcement Policy. How did Troy Health allegedly misuse AI in Medicare enrollments? Troy’s AI platform, Troy.ai, was used to manage enrollment lists and automate outreach, sometimes facilitating unauthorized beneficiary enrollments without consent or proper verification. What are the lessons for other healthcare companies? Healthcare organizations should maintain strong governance, compliance monitoring, and transparent self-reporting, especially when using AI systems that handle sensitive patient data. Stay informed and subscribe to JacobiJournal.com for up-to-date reporting on healthcare fraud and regulatory developments. 🔎 Read More from JacobiJournal.com:
Hospice Fraud and Mobile Job Scams: Identity Theft in Plain Sight
June 5, 2025 | JacobiJournal.com – Hospice fraud and mobile job scams have taken on new dimensions, particularly in healthcare and employment, where fraudulent actors are exploiting systemic vulnerabilities. Investigators have uncovered a disturbing trend: scammers are enrolling Medicare beneficiaries in hospice care without their knowledge, while fraudsters are targeting job seekers to steal personal information. Hospice Fraud: When Compassion Becomes a Cover Alarmingly, fraudsters are enrolling individuals, many of whom are not terminally ill, into hospice programs to generate false Medicare claims. In many cases, these schemes often involve identity theft, where scammers gain access to Medicare numbers through deceptive marketing, door-to-door pitches, or unsolicited calls. Once enrolled, victims often remain unaware until legitimate Medicare services are denied. This not only jeopardizes patient care but also defrauds government programs and taxpayers. Mobile Job Scams: The New Phishing Frontier Fraudsters now target job seekers through mobile-based job scams, posing as recruiters and sending convincing phishing emails.. These messages often include links that install malware like the AppLite Banker Trojan—designed to steal login credentials and sensitive information. What makes these attacks particularly dangerous is their sophistication. Fraudsters clone job websites and create professional-looking recruiter profiles to deceive and exploit their targets. What Legal and Compliance Teams Should Do The key to prevention lies in proactive vigilance and system-wide awareness. Here’s what experts recommend: Moreover, fraudulent hospice enrollment and mobile job scams are more than financial crimes—they erode public trust and endanger lives. With billions at stake, legal professionals, healthcare providers, and compliance officers must act as the first line of defense. FAQs: About Hospice Fraud, Job Scams, and Identity Theft What is hospice fraud and how does it happen? Hospice fraud involves enrolling people into Medicare-funded hospice care without their knowledge to submit false claims. How can job seekers avoid mobile job scams? Always verify recruiter emails, avoid clicking suspicious links, and never share sensitive information through text or messaging apps. Where can I report identity theft in healthcare or employment? Report healthcare fraud to Medicare.gov/fraud and employment-related scams to the FTC at IdentityTheft.gov. Stay ahead of rising threats like hospice fraud and job-based identity theft. Subscribe to JacobiJournal.com for weekly enforcement alerts, fraud case analysis, and compliance guidance tailored to healthcare and legal professionals. 🔎 Read More from JacobiJournal.com: