Women Charged with Defrauding Culinary Union's Health Care Insurance Program in Las Vegas
Las Vegas, Nev. – Two California women and two Las Vegas women have been charged with organizing and/or participating in a scheme to defraud the local Culinary Union's health care insurance program by submitting claims for unauthorized cosmetic surgeries performed on union members in Mexico, announced Greg Brower, United States Attorney for the District of Nevada.
"The Department of Justice has a longstanding commitment to health care fraud enforcement," said U.S. Attorney Brower. "We will use all of the tools we have available to prosecute individuals who participate in schemes to defraud health care insurance programs," said U.S. Attorney Brower.
Rebeca Acosta, 46, of Chula Vista, California, was indicted on April 22, 2009, by the Federal Grand Jury on three counts of Mail Fraud. Acosta was arrested on April 14, 2009, in San Diego, and released yesterday on a $150,000 surety bond. Three other women have been charged by Criminal Complaint for their involvement in the scheme. Ana Bertha Acosta, 39, of Dulzura, California, arrested on April 20, 2009, in San Ysidro, California, and Sara Casales, 47, of Las Vegas, arrested on April 14, 2009, in Las Vegas, are charged with Health Care Fraud and Aiding and Abetting. Lucia Solano, 49, of Las Vegas, arrested on April 14, 2009, in Las Vegas, is charged with making false statements to investigators.
According to the court records, in 2006, federal investigators initiated an investigation to determine if Las Vegas insurance providers were being targeted for fraudulent medical claims by Mexican medical providers. The investigators found that the Hotel and Restaurant Employees International Union Welfare Fund (Culinary Fund), which provides medical insurance services to at least 50,000 participants in the hospitality industry in the Las Vegas, Nevada area had been billed approximately $4.9 million for "out of country" claims for the time period of approximately January 2002 through February 2006, and that the "out of country" claims were almost entirely from Mexico. The majority of the claims were for emergency procedures in Mexico. When investigators began interviewing a number of the patients, they were told that the insurance claims were fabricated and that they had actually had cosmetic surgery in Mexico, not emergency services. The Culinary Fund does not provide coverage for cosmetic surgeries, unless they are medically necessary.
Rebeca Acosta and her co-schemers allegedly devised a scheme to defraud the Culinary Fund of money through the submission of fraudulent health care claims. Acosta and her co-schemers met with prospective patients at a residence in the Summerlin area of Las Vegas and elsewhere for the purpose of conducting cosmetic surgery consultations. Acosta told the prospective patients that she and her co-schemers could arrange for the Culinary Fund health insurance program to pay for cosmetic procedures, such as a breast augmentations or "tummy-tucks," even though such procedures were not covered through the program. Acosta represented to the patients that she would bill the Culinary Fund for the cosmetic procedure, but would make it appear as if the patient suffered an unexpected injury in Mexico and had received emergency medical treatment.
Acosta allegedly made arrangements for the prospective patients to receive a cosmetic procedure at a clinic in Tijuana, Mexico, and charged the patients a fee in addition to any reimbursement they would receive from the Culinary Fund. Acosta instructed the patients not to disclose the true nature of the treatment they received in Tijuana. Once the patients received the treatment in Tijuana, Acosta and her co-schemers submitted false and fraudulent claims to the Culinary Fund requesting reimbursement for emergency medical services, even though they knew that the patients had actually received cosmetic procedures. Between September and October 2005, Acosta allegedly submitted three fraudulent claims for reimbursement for emergency procedures purportedly performed on three patients. The Culinary Fund paid over $42,000 on the claims.
"This indictment sends a stern message to those medical providers that defrauding union health and welfare benefit plans by filing fraudulent claims will not be tolerated by my agency," said Daniel R. Petrole, Deputy Inspector General, U.S. Department of Labor." We are firmly committed to working with other law enforcement agencies to investigate this type of crime."
If convicted, Rebeca Acosta faces up to 20 years in prison and a $250,000 fine on each count; Ana Bertha Acosta and Sara Casales face up to 10 years in prison and a $250,000 fine; and Lucia Solano faces up to five years in prison and a $250,000 fine.
The case is being investigated by the Office of Inspector General for the U.S. Department of Labor, and the U.S. Postal Inspection Service. It is being prosecuted by Assistant United States Attorney Crane Pomerantz.
The public is reminded that a Indictment contains only charges and is not evidence of guilt. The defendants are presumed innocent and entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.