Woman Pleads Guilty to Defrauding Culinary Union
Las Vegas, Nev. – A California woman pleaded guilty today to defrauding the Culinary Union's health care insurance program, announced Daniel G. Bogden, United States Attorney for the District of Nevada.
Ana Bertha Acosta, 40, of Dulzura, California, pleaded guilty to three counts of health care fraud, and is scheduled to be sentenced on May 27, 2010, at 9:00 a.m. before Senior U.S. District Judge Lloyd D. George. She faces up to10 years in prison and a $250,000 fine on each count. The plea agreement states that Acosta agrees to forfeit and pay restitution in the amount of $959,735 to the Culinary Union's health care fund, although she can argue for a lesser amount at the time of sentencing.
According to the facts set forth in Acosta's plea agreement, from about June 2000 to June 2007, Acosta and several co-schemers submitted fraudulent health care claims to the Culinary Union's health care insurance program representing that union members had obtained emergency medical services in Mexico, when they actually received cosmetic procedures such as breast augmentations and "tummy tucks." The union's insurance program does not provide coverage for cosmetic surgeries, unless they are medically necessary.
The investigation was initiated in 2006 to determine if Las Vegas insurance providers were being targeted for fraudulent medical claims by Mexican medical providers. Investigators found that the Culinary Union's health care insurance program, 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.
Acosta's sister Rebeca Acosta, 47, was also charged in the scheme and is currently scheduled for trial beginning April 12, 2010.
The cases are being investigated by the Office of Inspector General for the U.S. Department of Labor and the U.S. Postal Inspection Service. They are being prosecuted by Assistant United States Attorney Crane Pomerantz.