Mexican Clinic Doctor Detained in Scheme to Commit Wire Fraud
McALLEN, Texas ‐ Two physicians from a family medicine clinic in Mexico have been charged in a federal indictment for their role in a scheme to submit false and fraudulent insurance claims, announced U.S. Attorney Kenneth Magidson.
According to the indictment, Dr. Mayolo Melchor, 58, and Dr. Bertha Hernandez-Melchor, 60, both of Reynosa, Tamaulipas, Mexico, conspired with policy holders of the American Family Life Insurance Company (AFLAC) to fax more than 50,000 fraudulent claim forms and accident reports to AFLAC for accidents and injuries that never occurred. The indictment charges the defendants with one count of conspiracy to commit wire fraud and eight counts of wire fraud.
The indictment was returned on June 14, 2011 and later arrested in Mexico. They were subsequently extradited to Houston and made an initial appearance on Jan. 22, 2015. Today, Hernandez-Melchor appeared before U.S. Magistrate Dorina Ramos in McAllen, at which time she was ordered into custody pending further criminal proceedings. Melchor will appear for his detention hearing Thursday, Feb. 4, 2016.
According to the indictment, policyholders for AFLAC paid the defendants to prepare and sign false reports for accidents and injuries that never occurred. The AFLAC policy holders would allegedly fill out false claims forms in the McAllen area and deliver them to the defendants’ family medicine clinic in Mexico where the defendants would prepare and sign corresponding accident reports for each fake accident and injury, according to the charges.
The indictment alleges that from September 2001 to August 2010, the defendants and the policyholders caused more than 50,000 fraudulent claim forms and accident reports to be faxed to AFLAC, resulting in the disbursement of approximately $5 million in benefit checks to the policyholders.
Conspiracy to commit wire fraud and each of the eight counts of wire fraud carry a maximum punishment of 20 years in federal prison without parole and a $250,000 fine upon conviction.
The investigation leading to the charges was conducted by the FBI. Assistant U.S. Attorneys Tina Ansari and Michael Day are prosecuting the case.
An indictment is an accusation of criminal conduct, not evidence.
A defendant is presumed innocent unless convicted through due process of law.