The Department of Justice (DOJ) is charging a woman for a long-running healthcare fraud scheme: from 2017 to 2021, she billed a health insurer for sexual services offered to dockworkers at her California “wellness centers.”
Sara Victoria, the “ringleader” of the scheme, hired women through Long Beach strip clubs and referrals to provide the services at her three chiropractic and acupuncture businesses. Federal prosecutors are also charging eight more people, seven of them dockworkers, who allowed her to submit the false claims to the International Longshore and Warehouse Union-Pacific Maritime Association (ILWU-PMA) health plan in exchange for sexual services.
According to her plea agreement, Victoria billed the health insurance plan — which covered chiropractic services with no deductible or out-of-pocket costs — for chiropractic and physical therapy using the dockworkers’ names, or the names of their family members, for over $2.1 million in fake claims. In return, Victoria paid ILWU-PMA plan members cash kickbacks, facilitating the operation through coded language in text messages, court documents say. She ultimately collected around $550,000.
The ILWU said in a press release that it “has denounced fraudulent claims allegedly made against its ILWU-PMA Welfare 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 fraudulent use of the benefits in our contract that longshore workers have fought for, and sometimes died for, over the past 90 years,” said ILWU Coast Committeeman Frank Ponce De Leon in the statement.
Victoria admitted to using someone else’s identity without their consent while fraudulently billing, and was charged with “one count of conspiracy to commit health care fraud and one count of aggravated identity theft.” The DOJ reports that when Victoria enters a guilty plea in court, she may face 12 years in federal prison.
Another defendant is Cameron Rahm, a longshoreman, ILWU member, and an alleged customer at Victoria’s businesses. DOJ alleges that he agreed to let her submit the false claims and lied to FBI agents about it.
It’s not the first time the longshoreman’s union has been embroiled in a fraudulent insurance claims scheme.
In 2019, another chiropractor for the ILWU-PMA plan, Darren Hines, pleaded guilty to healthcare fraud. He had billed the plan for services under another provider’s name and services that weren’t medically necessary.
In 2016, David Gomez and Sergio Amador were convicted of mail fraud for running an operation that billed the ILWU-PMA plan for services that weren’t provided or medically necessary. Again, this was done largely through chiropractic services.
Gomez and his partner opened clinics and created medical management companies that they used to route funds from the clinics to themselves, and to pay ILWU members with so they would use their clinics. Again, they used false signatures and names of ILWU family members to make fraudulent claims to the plan. Gomez made about $3 million from the scheme, and was sentenced to 20 years in prison.
In 2013, fraudulent claims made to the same union benefits plan contributed to a backlog of more than 100,000 claims. Slow claims processing times by the plan administrator meant some workers’ medical claims went to collections. This, in turn, prompted demonstrations by union members and a labor shortage.
Source: MedicalNewsToday.com
