Fraudsters R Us

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Surgeon picking up surgical tool from tray. Surgeon is preparing for surgery in operating room. He is in a hospital.

There are insurance policies for just about everything. There’s no doubt that policies covering long-term disability, life, health, homeowner’s and automobile insurance are necessary. But Melissa Alvarez Torres and Jose Luis Olmos Hernandez, both of Chula Vista, Calif., sold bogus insurance to pregnant women living in Mexico promising a legal American birth for their unborn babies. The healthcare fraud scheme stole more than $1 million from California’s Medi-Cal Access Program (MCAP).

Alvarez and Olmos began marketing their private insurance or “Seguros Americanos Embarazo” (American Pregnancy Insurance) on Facebook in 2016. They targeted pregnant women who held work or tourist visas, which would permit them to enter the United States. Interested women would contact Alvarez and Olmos through Facebook or WhatsApp. These victims were falsely promised that their private insurance would ensure a legal U.S. birth without risk to their visas. (If it sounds too good to be true, it probably is.)

Alvarez and Olmos targeted California’s Medi-Call Access Program, or MCAP, which provides pregnant women with comprehensive coverage for a low cost with no copayments or deductibles for its covered services. It’s generally for middle-income families who don’t have health insurance or their whole income is too high for no-cost Medi-Cal. (The two fraudsters were familiar with the program because they used it twice for their family.)

Many of the women victimized in this scheme were first-time mothers with high-risk pregnancies. They wanted high quality American health care and could not use a public health program or be at risk for losing their visas. (Who could blame them for wanting a safe delivery, except for the fact that this scheme was illegal?)

Alvarez and Olmos took advantage of these women and charged them between $1,200 and $3,000 for each pregnancy. The two then submitted hundreds of false applications and bogus tax and employment documents to MCAP, using the personal identifying information to claim that they were California residents. (The victims were not aware that this was being done on their behalf, nor did they consent.) Alvarez took it a step further and impersonated many of the victims in phone calls to MCAP to expedite the approval of the applications.

This healthcare fraud scheme cost MCAP and American taxpayers more than $1 million in losses. Where did the $1 million go, you ask? Alvarez and Olmos bought multiple properties in Mexico, including a beachfront home in Nayarit. (We should all be so lucky to have a beachfront home paid for by another country’s government.)

Alvarez and Olmos received 33 months and 40 months in prison, respectively, for committing healthcare fraud. Alvarez will pay nearly $22,000 in restitution to California’s MCAP program for the benefits that she, Olmos, and their children collected by concealing the fraud proceeds and the properties she and Olmos owned in Mexico. In addition, both Alvarez and Olmos will pay $424,500 in criminal proceeds and more than $1.5 million in restitution to the State of California and their 283 victims. (If they were to open up an insurance business, they could call it Fraudsters R Us. I doubt it would last very long.) 

Today’s Fraud of the Day comes from a Department of Justice press release, “Chula Vista Couple Sentenced for Fraud Scheme Targeting Pregnant Women,” dated October 26, 2021.

SAN DIEGO – Melissa Alvarez Torres and Jose Luis Olmos Hernandez were sentenced in federal court today to 33 months and 40 months in prison, respectively, for stealing hundreds of thousands of dollars from pregnant women and using the money to buy multiple properties in Mexico, including a beachfront home in Nayarit.

The couple from Chula Vista pleaded guilty in July, admitting that during a four-year period, their healthcare fraud scheme to sell bogus insurance to pregnant women caused more than $1 million in losses to California’s Medi-Cal Access Program known as MCAP.

 

 

 

 

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.