Monday, June 6, 2016

Two doctors from Mexico pleaded guilty in connection with a conspiracy to commit wire fraud that resulted in nearly $3 million in insurance claim payouts


Reynosa doctors admit to role in insurance fraud scheme
Charges stem from four-year case involving fraudulent claims, accident reports

LORENZO ZAZUETA-CASTRO | STAFF WRITER
Jun 1, 2016

McALLEN — Two doctors from Mexico pleaded guilty in connection with a conspiracy to commit wire fraud that resulted in nearly $3 million in insurance claim payouts, according to a news release.

Mayolo Melchor, 59, and Bertha Hernandez-Melchor, 61, both of Reynosa, pleaded guilty Wednesday to conspiring with more than 30 policyholders of the American Family Life Assurance Company to fax fraudulent claim forms and accident reports to the insurance company for accidents and injuries that did not happen, according to the release.

Melchor and Hernandez-Melchor admitted AFLAC policyholders paid them to prepare and sign fictitious reports for accidents and injuries that never occurred in exchange for payment, the release states.

AFLAC policyholders filled out the fictitious claim forms in the McAllen area and delivered them to the defendants’ family medicine clinic in Mexico where Melchor and Hernandez-Melchor prepared and signed corresponding accident reports for each fake accident and injury. The policyholders then faxed the fictitious claim and accident forms to AFLAC headquarters in Columbus, Georgia, according to court documents.

Melchor and Hernandez-Melchor admitted the fake claim forms and accident reports that were faxed to the insurance company from September 2001 to August 2010 resulted in the release of more than $2.5 million in fraudulent benefit checks to the policyholders, according to court records.

In total 36 people were convicted in connection with the wire fraud scam which included people from all across the Rio Grande Valley.

Named in the indictment was a Hidalgo police officer, a former Hidalgo County jail worker, other county employees and schoolteachers, according to court records.

In a four-year span, the defendants allegedly racked up more than 21,600 false injury claims accompanied by the doctors’ accident reports, to AFLAC’s claims department, according to the indictment.

The pair were originally named in the indictment on June 14, 2011, and arrested in Mexico. They were subsequently extradited to Houston and made an initial appearance on Jan. 22, 2015, according to court records.

In early February, Melchor and Hernandez-Melchor appeared in federal court in McAllen for their initial appearance hearing, according to court documents.

Sentencing for the doctors is scheduled for Aug. 18 where they could receive up to 20 years in federal prison and a $250,000 fine, according to the release.