Health Law Daily Wrap Up, FRAUD AND ABUSE—SETTLEMENT AGREEMENTS: ACA fraud claims resolved in $135M settlement, (Apr 17, 2026)

By Patricia K. Ruiz, J.D.

The government alleged the parties engaged in the submission of false enrollment applications and improper subsidy payments.

AssuredPartners Inc. and its former subsidiary, AP of South Florida LLC, have agreed to pay a combined $135 million to resolve civil allegations tied to an Affordable Care Act enrollment fraud scheme, according to the Department of Justice. The resolution includes a guilty plea by AP of South Florida to one count of major fraud against the United States and a parallel civil settlement resolving claims under the False Claims Act (FCA). The government had alleged that, from February 2021 through September 2022, false or fraudulent applications for subsidized ACA plans were submitted on behalf of thousands of consumers (Settlement Agreement (Mar. 20, 2026)).

Allegations. The government alleged that AP of South Florida used third party “street marketers” to solicit individuals at locations such as homeless shelters, bus stops, and drug treatment facilities and sometimes offered cash or gift cards for enrollments or personal information. According to the settlement, employees submitted applications listing qualifying income levels without regard to accuracy and, in some instances, submitted false or unverified information to Florida’s Medicaid program to obtain denial letters used to trigger special enrollment periods. The government further alleged that commissions and related payments from insurers flowed in significant part to AssuredPartners, then the parent company of AP of South Florida.

Settlement. Under the civil settlement, AssuredPartners agreed to pay $107,369,180, including $53,684,590 in restitution, plus interest, while AP of South Florida agreed to pay $27,630,820 in restitution. The AssuredPartners payment accrues interest at 4.25 percent from February 6, 2026, through the agreement’s effective date. AP of South Florida will fund an escrow account corresponding to its restitution obligation under a related plea agreement. The civil settlement resolves allegations originally brought by a whistleblower under the FCA and provides the relator an 18 percent share of the recovery. The agreement states that the relator will receive approximately $24.3 million following payment of the settlement amounts.

CIAsSettlementAgreements: SettlementAgreementsNews CMSNews FraudNews MedicaidNews