McAllen Woman Convicted for Role in Aflac Insurance Fraud Scam

Guilty Plea Marks the 36th Conviction in Multi-Million-Dollar Conspiracy

MCALLEN, TX—Another south Texas resident has been convicted in relation to a multi-million-dollar conspiracy to defraud the American Family Life Assurance Company (Aflac), United States Attorney Kenneth Magidson announced today.

A total of 36 persons were charged in mid-June 2011 in a number of indictments for their roles in a conspiracy to defraud Aflac of millions of dollars by filing false injury claims. Prior to today’s hearing, 35 of the defendants had been convicted for their roles in the scheme. Today, the final defendant, Maria Guzman, 42, of Edinburg, Texas, pleaded guilty to making false statements relating to health care matters before U.S. District Judge Micaela Alvarez. With this conviction, all 36 defendants have been convicted of felony offenses for their respective roles in the conspiracy.

According to information presented by the United States in court, Guzman was a policyholder under Aflac’s Accident-Only Insurance Plan and, from 2005 to 2010, delivered lists of fake accidents and injuries to two licensed physicians who worked together in Reynosa, Tamaulipas, Mexico. The physicians allegedly prepared an “accident report” for each fake injury in exchange for a cash kickback of approximately $15 per report. In these accident reports, the physicians falsely claimed they had provided treatment and prescribed medicine to Guzman for her purported injuries. Over time, Guzman and other policyholders participating in the conspiracy with the physicians faxed more than 22,000 false injury claims, accompanied by the physicians’ fraudulent accident reports, to Aflac’s claims department in Columbus, Georgia, causing Aflac to disburse more than $3 million in insurance proceeds. The physicians and policyholders attempted to conceal their scheme in numerous ways, such as agreeing to use minor injuries—including lacerations and burns—as opposed to more serious injuries that paid higher cash benefits but could potentially attract a greater level of scrutiny by Aflac’s claims department.

Guzman has been permitted to remain on bond pending her sentencing hearing, which has been scheduled for June 29, 2012 at 9:00 a.m. At that time, Guzman faces up to five years in federal prison without parole, a $250,000 fine, and mandatory restitution for her false statements conviction.

The ongoing investigation leading to the charges was conducted by the FBI, with valuable assistance from Aflac’s Special Investigations Unit. Assistant United States Attorney Gregory S. Saikin is prosecuting the case.