McAllen, Texas – In a shocking case of corruption, two physicians from a family medicine clinic in Mexico have been convicted of conspiracy to commit wire fraud in a scheme that netted over $2.5 million in false insurance claims.
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.
According to court documents, the defendants admitted that AFLAC policyholders paid them to prepare and sign fictitious reports for accidents and injuries that never occurred. The policyholders would fill out the fictitious claim forms in the McAllen area and deliver them to the defendants’ family medicine clinic in Mexico, where Melchor and Hernandez-Melchor would prepare and sign corresponding accident reports for each fake accident and injury.
The policyholders would then fax the fictitious claim and accident forms to AFLAC headquarters in Columbus, Georgia. The defendants admitted that 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.
The scheme was uncovered by the FBI, who investigated the case. Assistant U.S. Attorneys Michael Day and Tina Ansari are prosecuting the case.
The defendants face up to 20 years in federal prison and a possible $250,000 fine. Judge Micaela Alvarez has set sentencing for August 18 at 2:00 p.m.
The case highlights the growing problem of insurance fraud in the United States and the importance of holding perpetrators accountable for their crimes.
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Key Facts
- State: Texas
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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