Operators of a Purported Private Insurance Sales Company Indicted for Defrauding the California Medi-Cal Program and Pregnant Ladies

Operators of a Purported Private Insurance Sales Company Indicted for Defrauding the California Medi-Cal Program and Pregnant Ladies

San Diego, California – Jose Luis Olmos Hernandez and Melissa Alvarez Torres, a couple from Chula Vista who run what they professed to be a private insurance sales firm, made their first appearances on 24th September 2020 in federal court on accusations that they schemed to swindle hundreds of pregnant women and triggered an estimated 1.6 million U.S. dollars in losses to Medi-Cal, a government-funded health care system.

As per an indictment opened on 24th September 2020, between 2016 and September 2020 Melissa Alvarez and Jose Olmos schemed to swindle the Medi-Cal Access Program, a health care system managed by the California Health Care Services Department and sponsored by federal and state government money. The Medi-Cal Access Program is a health care program intended to help the working middle-class California families without sufficient health insurance by insuring post-natal care and maternity services for a low cost based on their earnings.

It was purported in the charge that Melissa Alvarez and Jose Olmos advertised private insurance to pregnant Mexican citizens with work or tourist visas. Via Facebook marketing under the name Seguros Americanos Embarazo (American Pregnancy Insurance), Melissa Alvarez and Jose Olmos deceitfully claimed that their insurance product would allow these pregnant ladies to give birth lawfully in the U.S., without compromising their visas by utilizing government services. They billed the pregnant ladies thousands of U.S. dollars each for the alleged insurance.

As a matter of fact, however, Alvarez Melissa and Jose Olmos never had private insurance to trade. Rather, they utilized the women’s personal identifying info to enroll them for the Medi-Cal Access Program benefits. As indicted in the indictment, Melissa Alvarez and Jose Olmos submitted hundreds of forged applications and deceptive supporting tax and employment papers to the Medi-Cal Access Program, professing that the pregnant women were qualified for benefits when in reality they were not eligible, and never gave permission to be enrolled for the program. Consequently, it was purported that Melissa Alvarez and Jose Olmos cost U.S. taxpayers millions of U.S. dollars in health care expenses in addition to the hundreds of thousands in charges they collected from the pregnant ladies they swindled.

Melissa Alvarez and Jose Olmos were apprehended on 23rd September 2020 as an outcome of a multiagency inquiry started by the California Health Care Services Department, under the Travel and Residency Enforcement Co-Op with the Office of the U.S. Attorney for California’s Southern District and Social Security Administration, together with the FBI (Federal Bureau of Investigation).

The United States Attorney Brewer stated that they would never entertain or tolerate offenders who attempt to enrich themselves and exploit vital public health systems and helpless pregnant ladies. Brewer further assured that they would continue to safeguard the U.S. taxpayer and ensure the integrity of health programs designed to support the needy Americans by investigating and holding accountable criminals who would attempt to take advantage of these health programs.

Will Lightbourne, California Health Care Services Department Director, stated that they appreciated the key assistance their law enforcement partners offered in this investigation to arrest persons exploiting some of the most vulnerable members in the society, and their support in safeguarding the Medi-Cal program’s integrity.

Special Agent Suzanne Turner in Charge of the FBI (Federal Bureau of Investigation) stated that Every day, Federal Bureau of Investigation agents are working zealously to unseal fraud against the U.S. government.  Special Agent Suzanne Turner added that in this matter, investigators unsealed a purported 1.6 million U.S. dollar loss from the California Medi-Cal Program and deceitfully acquired funds from hundreds of pregnant ladies who believed they were buying genuine insurance coverage for their health care wants. The federal healthcare programs’ viability depends upon legitimate utilization of the programs for those in need. Special Agent Suzanne Turner concluded the statement by assuring that the Federal Bureau of Investigation remains committed and dedicated in the vital work of discovering health care fraud in collaboration with California Health Care Services Department and other law enforcement partners.

The victims of Melissa Alvarez and Jose Olmos or the pregnant mothers who bought health care insurance via Seguros Americanos Embarazo are advised to contact the California Health Care Services Department through/at 1-800-822-6222.

The Accused Persons Case Number; 20-mj-4076

  • MELISSA ALVAREZ TORRES, from Chula Vista, California, age 33
    • alias Melissa Torres
    • alias Melissa A. Torres
  • JOSE LUIS OLMOS HERNANDEZ, from Chula Vista, California, age 36
    • alias Jose Luis Hernandez
    • alias Jose L. Hernandez
    • alias Jose Carlos
    • alias Carlos Garcia

 INDICTMENTS SUMMARY

  • Scheme to execute Health Care Fraud Scheme and Wire Fraud; Title 18, U.S.C., Section 1349
  • Maximum Punishment; Twenty years imprisonment in federal prison and 250,000 U.S. dollars fine, or double the total profits or twice the total loss, whichever is greater. Besides, restitution is mandatory.

 Investigating Agencies

  • The California Health Care Services Department
  • The FBI (Federal Bureau of Investigation)

NOTE: The allegations and charges contained in a charge or complaint are just accusations, and the accused are considered innocent until or unless proven guilty.

Breaking False Claim Act, Anti-Kickback Statute, and the Controlled Substance Statute is severely punished by the law. Additionally, scheming to commit health care fraud by defrauding federally-funded health care systems like Medicaid, TRICARE, or Medicare programs is a serious crime. Any person who executes these offenses violates the law and is severely punished or fined if found guilty or liable of the charges against them. When charged with these offenses, you should look for the finest legal assistance or representation to protect and pursue your rights. Hire our most sough-after team of skilled and top-rated defense and criminal attorneys if you need the best legal advice and representation, which will result in attaining positive outcomes for your matter. At Health Care Fraud Group, we have an experienced team of defense and criminal attorneys with many years of experience in handling Health Care Fraud related cases associated with the Federal Health Care Program; they are very knowledgeable about civil and federal issues. The defense attorneys are well recognized across the U.S. because of their excellent work and professionalism when handling health care fraud matters and investigations. They are highly equipped with previous knowledge of each aspect of Health Care fraud defense, medical, and legal issues.

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