SAN DIEGO – On September 24, 2020, Melissa Alvarez Torres and Jose Luis Olmos Hernandez, a Chula Vista couple who operated what they claimed to be a private insurance sales company, made their first  appearances in federal court on charges they conspired to defraud hundreds of pregnant women and caused an estimated $1.6 million in losses to Medi-Cal, a government health care program.

According to the complaint, from 2016 through the present, Alvarez and Olmos conspired to defraud the Medi-Cal Access Program (“MCAP”), a health care program administered by the California Department of Health Care Services and funded by state and federal government funds. MCAP is a program designed to assist working, middle-income California families without adequate health insurance by covering maternity services and post-natal care for a low cost based on their income.

It is alleged in the complaint that Alvarez and Olmos marketed private “insurance” to pregnant Mexican nationals holding work or tourist visas. Through Facebook advertising under the name Seguros Americanos Embarazo (“American Pregnancy Insurance”), Alvarez and Olmos are accused of falsely claiming that their “insurance” product would permit these pregnant women to give birth legally in the United States, without jeopardizing their visas by using government services. They charged the pregnant women thousands of dollars each for the purported “insurance.”

In reality, however, Alvarez and Olmos did not have private insurance to sell. Instead, they used the women’s personal identifying information to sign them up for MCAP benefits. As charged in the complaint, Alvarez and Olmos submitted hundreds of false applications and fraudulent supporting tax and employment documents to MCAP, pretending that the women were eligible for benefits when in fact they did not qualify—and did not consent to be signed up for the program. As a result, it is alleged that Alvarez and Olmos cost American taxpayers millions of dollars in health care costs on top of the hundreds of thousands in fees they collected from the women they defrauded.

Alvarez and Olmos were arrested on September 23, 2020  as a result of a multiagency investigation initiated by the California Department of Health Care Services, pursuant to the Travel and Residency Enforcement Co-Op with the Social Security Administration and the United States Attorney’s Office for the Southern District of California, along with the Federal Bureau of Investigation.

“California Department of Health Care Services investigators work to safeguard programs that help people who need assistance,” said California Statewide Law Enforcement Association (CSLEA) President Alan Barcelona.  “Stealing from these programs is stealing from all of us as as tax payers.”

“We appreciate the crucial support our partners provided in this investigation to apprehend people preying on some of society’s most vulnerable members, and their assistance in protecting the integrity of the Medi-Cal program,” said DHCS Director Will Lightbourne.

“In this case, investigators uncovered an alleged $1.6 million dollar loss from the California Medi-Cal Program as well as fraudulently obtained money from hundreds of pregnant women who thought they were purchasing legitimate insurance coverage for their health care needs. The viability of government healthcare programs depends on honest use of the programs for those in need,” said FBI Special Agent in Charge Suzanne Turner.  “Therefore, the FBI remains steadfast in the important work of uncovering healthcare fraud in partnership with California’s Department of Health Care Services and other law enforcement agencies.”

SUMMARY OF CHARGES

Conspiracy to Commit Health Care Fraud and Wire Fraud – Title 18, U.S.C., Section 1349

Maximum penalty: 20 years in custody and a $250,000 fine, or twice the pecuniary gain or twice the pecuniary loss, whichever is greater. Restitution is mandatory.