McALLEN, Texas ‐ Two physicians from a family medicine clinic in Mexico have been convicted of conspiracy to commit wire fraud for their role in a scheme to submit false and fraudulent insurance claims, announced U.S. Attorney Kenneth Magidson.
Dr. Mayolo Melchor, 59, and Dr. Bertha Hernandez-Melchor, 61, both of Reynosa, Tamaulipas, Mexico, pleaded guilty to conspiring with policyholders of the American Family Life Assurance Company (AFLAC) to fax fraudulent claim forms and accident reports to AFLAC for accidents and injuries that never occurred. Both plea agreements were entered today before U.S. District Judge Micaela Alvarez.
The defendants admitted AFLAC policyholders paid them to prepare and sign fictitious reports for accidents and injuries that never occurred. AFLAC policyholders filled out the fictitious claim forms in the McAllen area and delivered them to the defendants’ family medicine clinic in Mexico where Melchor and Hernandez-Melchor prepared and signed corresponding accident reports for each fake accident and injury. The policyholders then faxed the fictitious claim and accident forms to AFLAC headquarters in Columbus, Georgia.
The defendants admitted the fraudulent claim forms and accident reports that were faxed to AFLAC from September 2001 to August 2010 resulted in the disbursement of approximately $2,585,219.50 in fraudulent benefit checks to the policyholders.
Judge Alvarez has set sentencing for Aug. 18 at 2:00 p.m., at which time both defendants face up to 20 years in federal prison and a possible $250,000 fine. They will remain in custody pending that hearing.
The FBI investigated. Assistant U.S. Attorneys Michael Day and Tina Ansari are prosecuting the case.
Source: U.S. Department of Justice, Federal Bureau of Investigation (FBI)
