Department of Justice (DOJ) charge a woman For Long-Term Health Care Fraud Scheme: 2017 to 2021 billed a health insurance company for sexual services provided to dock workers at California “wellness centers.”
Sarah Victoria, the “project leader,” hired women through Long Beach strip clubs and referrals to provide services in her three chiropractic and acupuncture businesses. Federal prosecutors also charged eight other people, seven of them dockers, who allowed her to make false claims to the Longshore and Warehouse Union-Pacific Maritime Association (ILWU-PMA) in exchange for sexual favours.
According to her plea agreement, Victoria billed the health insurance plan — which covered chiropractic services with no deductible or out-of-pocket costs — for chiropractors and physical therapy using the names of dockers, or their family members, for more than $2.1 million of False claims. In return, Victoria paid ILWU-PMA members cash bribes, facilitating the process through language encoded in text messages, court documents say. She eventually raised about $550 thousand.
ILWU . said In a press release It “deplores the fraudulent allegations allegedly made against its ILWU-PMA care plan by seven workers and three health care providers.”
“Our union is proud to have negotiated health benefits with our employer that we believe all Americans should have. We will not tolerate the fraudulent use of benefits in our contract for which long-term office workers have fought, and sometimes died, over the course of the ninety years. In the past, Frank Ponce de Leon said in the statement.
Victoria has admitted to using someone else’s identity without their consent while submitting bills fraudulently, and has been charged with “one count of conspiracy to commit health care fraud and one count of aggravated identity theft”. The Department of Justice has stated that when Victoria pleads guilty in court, she could face 12 years in federal prison.
The other accused is Cameron Ram, a stevedoring worker, ILWU member, and alleged customer of Victoria’s Business. The Department of Justice alleges that he agreed to allow her to make the false allegations and lied to FBI agents about them.
This is not the first time that the longtime freight workers union has been involved in Fraudulent insurance claims Scheme.
In 2019, another ILWU-PMA chiropractor, Darren Hines, pleaded guilty to health care fraud. He billed the services plan under another provider’s name and services that were not medically necessary.
In 2016, David Gomez and Sergio Amador Convicted of mail fraud To run a process billed to an ILWU-PMA plan for services that were not provided or that were medically necessary. Again, this was largely done through chiropractic services.
Gomez and his partner opened clinics and created medical management companies that they used to funnel money from the clinics to themselves, and pay ILWU members so they could use their clinics. Once again, they used fake signatures and names of ILWU family members to make fraudulent claims to the plan. Gomez made about $3 million off the scheme, and was sentenced to 20 years in prison.
In 2013, Submit fraudulent claims to the same union benefit plan that has contributed to the backlog of more than 100,000 claims. Slow claims processing times by the plan administrator have resulted in some workers’ medical claims being transferred to groups. This, in turn, led to demonstrations by union members and labor shortages.
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