Calif. U.S. Attorney: Former U.S. Navy Service Member Pleads Guilty to $2M Insurance Fraud Scheme

SAN DIEGO, California, Oct. 28 -- The U.S. Attorney for the Southern District of California, Randy Grossman, issued the following news release on Oct. 27, 2022:

Christopher Toups, who at the time of his crimes was a chief petty officer in the U.S. Navy, pleaded guilty in federal court today, admitting that he and others participated in a scheme to file false claims to obtain unearned benefits from an insurance program that compensates service members who suffer serious and debilitating injuries while on active duty.

According to his plea agreement, participants in the scheme obtained approximately $2 million in payments from fraudulent claims submitted to the insurance program - Traumatic Servicemembers Group Life Insurance Program, or TSGLI - and Toups personally obtained about $400,000.

At today's hearing, Toups pleaded guilty to conspiracy to commit wire fraud. He admitted that from 2012 to at least December 2015, he conspired with his then-spouse Kelene McGrath, Navy Dr. Michael Villarroel, and others to obtain money from the United States by making claims for life insurance payments based on exaggerated or fake injuries and disabilities. He is scheduled to be sentenced on February 3, 2023, at 9 a.m.

"The theft of military healthcare dollars directly harms service members and taxpayers," said U.S. Attorney Randy Grossman. "This fraud was costly for the U.S. Navy, and now for this defendant." Grossman thanked the prosecution team and investigating agencies for their excellent work on this case.

"Fraudulently filing claims for unearned TSGLI benefits diverts compensation from deserving service members who suffered serious and debilitating injuries while on active duty," said Special Agent in Charge Rebeccalynn Staples with the Department of Veterans Affairs Office of Inspector General's Western Field Office. "Worse yet, this defendant actively recruited others into the scheme to feed his greed for compensation he did not deserve. This guilty plea is a testament to the VA OIG's commitment to investigating those who would defraud benefit programs administered by VA."

"The Traumatic Servicemembers Group Life Insurance Program is designed to compensate service members who suffer serious and debilitating injuries while on active duty. Falsely claiming benefits from this program siphons money from deserving beneficiaries and makes medical care more costly for all of us," said Stacey Moy, Special Agent in Charge of the FBI San Diego Division. "This scheme is particularly egregious given the service members involved deceitfully served themselves for their own financial gain. The FBI will continue to work with our law enforcement partners to ensure those who willingly defraud the American people are held accountable."

The Traumatic Servicemembers Group Life Insurance (TSGLI) program was administered by Prudential for the Navy and funded by servicemembers and the Department of the Navy. TSGLI provided financial assistance to servicemembers recovering from traumatic injuries.

According to the plea agreement, in addition to submitting his own TSGLI claims based on fake injuries and disabilities, Toups encouraged numerous current or former Navy servicemembers to submit claims and sometimes told them to provide medical records to McGrath. McGrath, a nurse, falsified or doctored medical records to exaggerate or fake injuries. Villarroel certified that he reviewed the records and determined activities of daily living were lost or impaired and consistent with the claimed injuries as required for claims to be processed and qualify, at times supporting the determination by falsely stating he interviewed the claimant. Villarroel also, at times, provided others' medical records for McGrath to use in fabricating claims.

Toups admitted that he encouraged recipients of claim payments to give him part of the money, sometimes characterizing it as a "processing fee." McGrath and Villarroel received part of the kickback depending on their involvement in the claim. Toups paid Villarroel in cash and by cashier's check. At times, Toups and other conspirators conducted financial transactions in amounts under $10,000 to evade perceived financial reporting requirements.

According to court records, some of Toups' co-defendants were part of the Explosive Ordinance Disposal Expeditionary Support Unit One ("EOD ESU One"), based in Coronado, California. Toups was a Chief Petty Officer Construction Mechanic.

Ronald Olmsted and Anthony Coco, who each entered guilty pleas earlier this year, were previously sentenced by U.S. District Judge Janis L. Sammartino. Olmsted was sentenced to four months in prison followed by four months of home detention to be served as part of three years of supervised release. Coco was sentenced to four months of home detention to be served as part of three years of probation.

According to court records, Toups, Villarroel, and Meyer were at the center of the scheme, and together the conspirators defrauded the TSGLI program of nearly $2 million. Toups, Villarroel, and Meyer received kickbacks for creating and filing the fraudulent TSGLI applications for other U.S. Navy service members.

DEFENDANT - 18CR1674-JLS

Christopher Toups - 43 - Woodstock, GA

RELATED CASES

Kelene Meyer - 18CR1674-JLS - 44 - Jacksonville, FL

Dr. Michael Villarroel - 18CR1674-JLS - 48 - Coronado, CA

Paul Craig - 18CR1674-JLS - 47 - Austin, TX

Richard Cote - 18CR1674-JLS - 45 - Oceanside, CA

Earnest Thompson - 18CR1674-JLS - 46 - Murrieta, CA

Ronald Olmsted - 20CR0659-JLS - 48 - Mobile, AL

Anthony Coco - 20CR0197-JLS - 43 - San Diego, CA

Stephen Mulholland - 20CR0052-JLS - 51 - Panama City Beach, FL

SUMMARY OF CHARGES

Toups:

18 U.S.C. Sec. 1349, Conspiracy to Commit Wire Fraud

Maximum Penalty: Twenty years in prison, $250,000 fine, forfeiture and restitution

Others:

18 U.S.C. Sec. 1349, Conspiracy to Commit Wire Fraud

Maximum Penalty: Twenty years in prison, $250,000 fine, forfeiture and restitution

18 U.S.C. Sec. 1343, Wire Fraud

Maximum Penalty: Twenty years in prison, $250,000 fine, forfeiture and restitution

18 U.S.C. Sec. 287, Making a False Claim

Maximum Penalty: Five years in prison, $250,000 fine

AGENCIES

Federal Bureau of Investigation

Naval Criminal Investigative Service

Department of Veterans Affairs - Office of Inspector General

*The charges and allegations contained in an indictment or complaint are merely accusations, and the defendants are considered innocent unless and until proven guilty.

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Original text here: https://www.justice.gov/usao-sdca/pr/former-us-navy-service-member-pleads-guilty-2-million-insurance-fraud-scheme