Thursday, September 15, 2016
McALLEN, Texas ‐ Two physicians from a family medicine clinic in Mexico have been ordered to prison 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 June 1, 2016, 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.
Today, U.S. District Judge Micaela Alvarez handed both Melchor and Herndandez-Melchor sentences of 34 months in federal prison. They were further ordered to pay $2,585,219.50 in restitution. In handing down the sentences, Judge Alvarez noted the large number of fraudulent claims submitted and the time period involved in the conspiracy. Both are expected to face deportation proceedings following release from federal prison.
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.
Both will remain in custody pending transfer to a U.S. Bureau of Prisons facility to be determined in the near future.
The FBI investigated. Assistant U.S. Attorneys Michael Day and Tina Ansari are prosecuting the case.