Doctor and Office Manager Indicted in Scheme to Defraud Medicare, Manufacture and Distribute Fentanyl
NEWS RELEASE SUMMARY – September 24, 2020
SAN DIEGO – Melissa Alvarez Torres and Jose Luis Olmos Hernandez, a Chula Vista couple who operated what they claimed to be a private insurance sales company, made their initial appearances today in federal court on charges that they conspired to defraud hundreds of pregnant women and caused an estimated $1.6 million in losses to Medi-Cal, a government health care program.
According to a complaint unsealed this afternoon, from 2016 through the present Alvarez and Olmos conspired to defraud the Medi-Cal Access Program ("MCAP"), a health care program administered by the California Department of Health Care Services and funded by state and federal government funds. MCAP is a program designed to assist working, middle-income California families without adequate health insurance by covering maternity services and post-natal care for a low cost based on their income.
It is alleged in the complaint that Alvarez and Olmos marketed private "insurance" to pregnant Mexican nationals holding work or tourist visas. Through Facebook advertising under the name Seguros Americanos Embarazo ("American Pregnancy Insurance"), Alvarez and Olmos falsely claimed that their "insurance" product would permit these pregnant women to give birth legally in the United States, without jeopardizing their visas by using government services. They charged the pregnant women thousands of dollars apiece for the purported "insurance."
In reality, however, Alvarez and Olmos did not have private insurance to sell. Instead, they used the women’s personal identifying information to sign them up for MCAP benefits. As charged in the complaint, Alvarez and Olmos submitted hundreds of false applications and fraudulent supporting tax and employment documents to MCAP, pretending that the women were eligible for benefits when in fact they did not qualify—and did not consent to be signed up for the program. As a result, it is alleged that Alvarez and Olmos cost American taxpayers millions of dollars in health care costs on top of the hundreds of thousands in fees they collected from the women they defrauded.
Alvarez and Olmos were arrested on Wednesday morning as a result of a multiagency investigation initiated by the California Department of Health Care Services, pursuant to the Travel and Residency Enforcement Co-Op with the Social Security Administration and the United States Attorney’s Office for the Southern District of California, along with the Federal Bureau of Investigation.
"We will not tolerate criminals who try to profit and take advantage of important public health programs and vulnerable pregnant women," said U.S. Attorney Brewer. "We will continue to protect the American taxpayer and ensure the integrity of programs intended to help the needy by investigating and prosecuting those who would try to exploit them."
"We appreciate the crucial support our partners provided in this investigation to apprehend people preying on some of society’s most vulnerable members, and their assistance in protecting the integrity of the Medi-Cal program," said DHCS Director Will Lightbourne.
"Each and every day, FBI agents are working diligently to uncover fraud against the government," said FBI Special Agent in Charge Suzanne Turner. "In this case, investigators uncovered an alleged $1.6 million dollar loss from the California Medi-Cal Program as well as fraudulently obtained money from hundreds of pregnant women who thought they were purchasing legitimate insurance coverage for their health care needs. The viability of government healthcare programs depends on honest use of the programs for those in need. Therefore, the FBI remains steadfast in the important work of uncovering healthcare fraud in partnership with California’s Department of Health Care Services and other law enforcement agencies."
If you think you are a victim of Alvarez and Olmos, or purchased health insurance through Seguros Americanos Embarazo, please contact the California Department of Health Care Services at 1-800-822-6222.
DEFENDANTS Case No. 20-mj-4076
MELISSA ALVAREZ TORRES Age 33 Chula Vista, CA
aka "Melissa Torres"
aka "Melissa A. Torres"
JOSE LUIS OLMOS HERNANDEZ Age 36 Chula Vista, CA
aka "Jose Luis Hernandez"
aka "Jose L. Hernandez"
aka "Jose Carlos"
aka "Carlos Garcia"
SUMMARY OF CHARGES
Conspiracy to Commit Health Care Fraud and Wire Fraud – Title 18, U.S.C., Section 1349
Maximum penalty: 20 years in custody and a $250,000 fine, or twice the pecuniary gain or twice the pecuniary loss, whichever is greater. Restitution is mandatory.
State of California’s Department of Health Care Services
Federal Bureau of Investigation
*The charges and allegations contained in an indictment or complaint are merely accusations, and the defendants are considered innocent unless and until proven guilty.
Special Assistant U.S. Attorney Lisa J. Sanniti (619) 546-8811
Special Assistant U.S. Attorney Jeffrey D. Hill (619) 546-7924