It is not uncommon to hear of criminals being discovered becausetheir stories just “don't add up.” In this case, the stories of 32people did add up … to a whopping $3 million in fraudulent insurance payouts.
|A recent FBI-led investigation in South Texas dubbed “OperationSitting Duck” led to the indictment of 32 people on federalinsurance fraud charges. Between 2001 and 2010, approximately21,600 purportedly fake claims for minor injuries and accompanyingdoctors' accident reports were submitted to AFLAC in a scheme involving those 32 people.
|Investigation revealed that two unnamed doctors at a Reynosa,Mexico family clinic were signing off on fake accident reports,receiving $10 to $15 for each alleged injury, and instructed thefraudsters to avoid requests from the insurer for X-rays or medicaltests. According to the indictments, compensation for each claim ranged from $100 to$500.
|What made this situation unique was the use of AFLAC'saccident-only insurance plan. Different than primary medicalinsurance, this policy is supplemental and covers costs afterunexpected injuries when a person is unable to work.
|Among those indicted were a police officer, county employees, and schoolteachers.
|According to prosecutors, anyone convicted will be required topay back fraudulently obtained funds. Additionally, those convictedface up to 20 years in prison and a $250,000 for eachcount of conspiracy and wire fraud.
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