DOJ AFLAC mail fraud

BC-DOJ-AFLAC-mail-fraud

To: NATIONAL EDITORS

Contact: Lymarie V. Llovet-Ayala of the Office of United States Attorney

Rosa Emilia Rodriguez-Velez, District of Puerto Rico, +1-787-282-1820

SAN JUAN, Puerto Rico, Dec. 15 /PRNewswire-USNewswire/ -- Late yesterday,

a federal grand jury issued a 162-count indictment, charging 101 defendants

with mail fraud conspiracy and mail fraud. A separate six-count indictment,

related to the same scheme, charged six individuals with mail fraud conspiracy

and mail fraud, announced Rosa Emilia Rodriguez-Velez, United States Attorney

for the District of Puerto Rico. Doctors Jose A. Fontanillas-Pino and Edwin

Perez-Loran, of Quebradillas, Puerto Rico, are the lead defendants in each

indictment. The victim of the offenses charged in both indictments was

American Family Life Assurance Company (AFLAC), which paid out over $800,000

to its policyholders as a result of the fraudulent scheme.

The first indictment alleges that from June 2004 until September 2008, Dr.

Fontanillas-Pino, who has a specialty in pediatrics, falsely completed and

signed the physician statement section of AFLAC's Accidental Injury Claim Form

and/or prescription form, falsely certifying injuries for AFLAC claimants

and/or policyholders. He falsely represented that the claimants had suffered

injuries, when in fact they had not sustained any such injuries, and Dr.

Fontanillas-Pino never conducted a physical examination of any of the

claimants. Fontanillas-Pino was paid $10 by the AFLAC claimants for each false

claim form that he completed and signed, and caused a total disbursement by

AFLAC of at least $877,925.00 in U.S. currency, by way of checks, that were

sent to the policyholders through the U.S. Postal Service.

Defendant number two of the first indictment, Luis Pagan-Gonzalez, was an

AFLAC accident insurance policyholder who at times served as an intermediary

between other AFLAC policyholders and Dr. Fontanillas. Pagan-Gonzalez

recruited and charged the policyholders $20 and paid Dr. Fontanillas $10 from

each false claim form that he completed and signed. Defendant number 59,

Ulises Ramos-Ramirez, was also an AFLAC accident insurance policyholder and at

times also served as an intermediary between other AFLAC policyholders and Dr.

Fontanillas. The remaining defendants were AFLAC accident insurance

policyholders, spouses and/or dependents who submitted false claim forms for

non-existent injuries to AFLAC.

The second indictment alleges that Dr. Edwin Perez-Loran falsely completed

and signed the physician statement section of AFLAC's Accidental Injury Claim

Form and /or prescription form, falsely certifying injuries for AFLAC

claimants and/or policyholders. Dr. Perez-Loran did not conduct a physical

examination in the majority of cases of AFLAC claimants and was paid $10 for

each false claim form he completed and signed. At the same time, the doctor

paid defendant Edgardo Gotay $4 for each false claim form that Gotay filled.

The other defendants: Rafael Rosado, Wilmarie Verges-Perez, Rosa E.

Nieves-Rivera and Israel Guzman-Valle are charged in both indictments.

"The doctors charged today used their medical licenses to unlawfully

enrich themselves at the expense of AFLAC. Their submission of false injury

claim forms on behalf of insured individuals caused AFLAC to disburse over

$800,000 for injuries which were non-existent. The price of this illegal

scheme is ultimately paid by the consumers, whose insurance premiums will

increase to cover the loss sustained by the company as a result of these

fraudulent claims. We will continue to investigate and prosecute those who

devise and participate in these fraudulent schemes to the full extent of the

law," stated U.S. Attorney Rodriguez-Velez.

If convicted, the defendants could face a maximum penalty of 20 years in

prison and/or fines of up to $250,000.

This investigation was conducted by the FBI and the case is being

prosecuted by Assistant U.S. Attorney Julia Diaz-Rex.

Criminal indictments are only charges and not evidence of guilt. A

defendant is presumed to be innocent until and unless proven guilty.

SOURCE U.S. Department of Justice

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