Criminal Justice News

Wednesday, April 18, 2012

Another South Texas Resident Sentenced to Prison for Defrauding Aflac

Twenty-Eight Now Sentenced to Prison in Connection with Multi-Million-Dollar Conspiracy

MCALLEN, TX—Another south Texas resident has been sentenced to federal prison in connection with a scheme to defraud the American Family Life Assurance Company (Aflac) by filing false injury claims under Aflac’s Accident-Only Insurance Plan, United States Attorney Kenneth Magidson announced today.

A total of 37 persons have been charged since June 2011 for their roles in a scheme designed to defraud Aflac of millions of dollars by filing thousands of false injury claims. To date, 36 of the defendants have been convicted, and 28 have been sentenced to prison for their participation in the scheme. Today, U.S. District Judge Micaela Alvarez sentenced Lucila Alcala, 41, of Edinburg, Texas, to 16 months in federal prison, without parole, and ordered her to pay $192,400 in restitution.

Alcala pleaded guilty in 2011 to one count of wire fraud, admitting that she engaged in a multi-year scheme as a policyholder of Aflac. Specifically, she routinely delivered lists of fake accidents and injuries to two physicians who practiced together in Reynosa, Tamaulipas, Mexico. The physicians prepared an “accident report” for each fake injury in exchange for a cash kickback of approximately $15 per accident report. In each report, the physicians falsely claimed they had provided treatment and prescribed medicine to Alcala for her purported injuries. Over time, Alcala and her co-conspirators faxed thousands of false injury claims and accident reports (purportedly certifying the fake injuries) to Aflac in Columbus, Georgia. Aflac disbursed more than $3 million as a result of the false claims submissions.

The investigation leading to the charges was conducted by the FBI. Assistant United States Attorney Greg Saikin is prosecuting the case.

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