Puerto Ricans arrested in health insurance scam

AP News
Posted: Dec 15, 2009 12:49 PM

Police have arrested two doctors and at least 42 patients accused of defrauding a major health insurance company, the U.S. attorney for Puerto Rico said Tuesday.

More than 100 people are accused of defrauding health insurer Aflac Inc. of nearly $1 million by paying two doctors to file false claims, federal officials said.

Most of the suspects are expected to turn themselves in on Wednesday, said Luis Fraticelli, Puerto Rico's FBI special agent in charge. The majority of the suspects are married couples facing charges including mail fraud and mail fraud conspiracy.

He said hundreds of other people were involved in the scheme and could be arrested soon.

Two doctors identified as Jose Fontanillas Pino and Edwin Perez Loran are accused of receiving $10 each for every falsified form they filed, allowing policyholders to collect more than $800,000 from Aflac, said U.S. Attorney Rosa Emilia Rodriguez.

"The price of this illegal scheme is ultimately paid by the consumers, whose insurance premiums will increase to cover the loss," Rodriguez said.

Fraticelli said more than 6,000 fake claims were submitted, with some policyholders filing more than 150 claims each.

The actions are alleged to have occurred from June 2004 through September 2008.

It was not clear if the suspects had attorneys. The doctors could face up to 20 years in prison if found guilty.