19 people claiming minor injuries indicted
McALLEN — Nineteen people face federal fraud charges for their purported roles in receiving more than $3.3 million in false insurance claims for minor injuries, such as slipping on wet cement or mouth burns from a hot slice of pizza.
Federal agents arrested 19 people Thursday who bought supplemental insurance policies from the American Family Life Assurance Company, commonly known as AFLAC, and filed the purportedly false policy claims.
Among the four indictments, prosecutors accuse the group of filing nearly 34,000 claims that resulted in more than $3.3 million in disbursements. Another eight people accused in the case had not been arrested as of Thursday evening.
Details of the alleged insurance fraud scheme became public when four indictments were unsealed Thursday in U.S. District Court in McAllen.
Prosecutors say the group worked with two unnamed doctors at a family clinic in Reynosa. The doctors would sign on the false accident reports, a separate document required to file a claim, and receive about $10 to $15 for each supposed injury.
The purported scheme lasted between September 2001 and August 2010, court documents state.
Unlike primary medical insurance, the AFLAC accident-only insurance plan is a supplemental policy intended to cover expenses such as rent, car payments and utility bills that could accumulate when the injured person is unable to work.
An AFLAC spokesperson did not return calls seeking comment.
It remains unclear exactly how much money each defendant purportedly earned from the fraud scheme, except in the case of one defendant.
Beatriz Carreon is named in a separate indictment that says she filed at least 580 false injury claims that reaped more than $63,500 in benefits, an average of about $109 per incident.
Two of the questionable claims are named in the indictment: One involved an injured right hand as she changed bed covers; the other came after she burned her tongue eating fried chicken.
Such is the case in the other claims, which include defendant Mary Cedillo, who bruised her leg when she was hit with a baseball. Or the claim of Idaleen Sanchez, who said she burned herself while cooking nachos. And prosecutors say Rebecca Castillo filed three questionable claims between April 2008 and August 2009, after cutting her thumb peeling potatoes, burning her mouth on a slice of pizza and slicing her arm while hanging wind chimes.
The list goes on with other defendants’ claims, key to their hopes of avoiding attention while seeking cash for their seemingly clumsy bumps and bruises.
Policyholders were eligible to receive about $100 for each cut and $500 for a fracture, though none of the claims in court documents include broken bones.
Prosecutors say the doctors coached each defendant on how to keep their injuries minimal — cuts, bruises and burns — and not more serious injuries that would reap more cash, but would require hard evidence from medical tests like X-rays.
After filing the claim form and accident report, typically via fax, AFLAC would cut a check to the policyholders to be spent as they wished.
Each person faces up to 20 years in prison and a maximum $250,000 fine for each fraud count. Most defendants are expected to appear before a U.S. magistrate judge at detention hearings set for today.
BOGUS BRUISES?
Allegedly false claims named in the four indictments unsealed Thursday are:
- Steven Betancourt, who says between July 2006 and May 2009, he cut his chin after tripping on a sidewalk, injured his leg while feeding the dog, burned himself with hot water, burned his arm while burning trash and dropped a hammer on his toe
- Jose D. Rodriguez, who claims he burned his right hand cooking pizza in January 2009 and burned his finger warming up a tortilla in February 2009
- Lucia Alcala, who filed claims after apparently burning her arm making tortillas in November 2008 and in March 2007, when she said she cut her finger with a pizza cutter
- Rebecca Castillo, who says between April 2008 and August 2009, she cut her thumb peeling potatoes, cut herself while hanging wind chimes and burned her mouth on a slice of pizza
- Beatriz Carreon, who hurt her hand changing bed covers and burned her tongue on a hot piece of fried chicken between August 2008 and February 2009
- Mary Cedillo, who says she bruised her leg after she was hit by a baseball in August 2006
- Yolanda Segovia, who claims she cut her thumb on a can of tuna in January 2009
- Candida Chavez, who said she bruised her elbow when she hit a basketball rim in September 2009
- Lori Chavez, who claimed she sliced her finger on a cheese grater in August 2006
- Anissa Chavez, who said she burned her hand while cooking in September 2009
- Homer Cedillo, who apparently was hurt after slipping on wet cement in June 2007
- Idaleen Sanchez, who says she burned herself cooking nachos in July 2008
- Norma Sanchez, who claims she sliced her finger while cutting beef in October 2008
- Valerio Ramos, who says he burned his hand while frying fish in April 2009
- Rigoberto Ramos, who said he cut his finger while slicing a tomato in July 2009
- Jose Guerra Jr., who claimed he burned his skin from a cup of hot coffee in October 2009
- Eddie Guerra, who purportedly banged his knee on the edge of a pickup truck door in May 2010
- Desiree Rodriguez, who claimed she burned her ear with a hair straightener in July 2006
- Maria Guzman, who says she cut her right hand while washing knives in July 2009
(Source: Indictments unsealed Thursday in U.S. District Court)
