McALLEN, Texas – A McAllen area insurance agent has been indicted on multiple counts of mail fraud and aggravated identity theft arising from a scheme to defraud several private insurance companies offering Medicare Advantage plans and other insurance products, United States Attorney Kenneth Magidson announced today.
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San Juana Lopez, 59, of Edinburg, Texas, was charged with five counts of mail fraud and three counts of aggravated identity theft in a federal indictment, returned under seal Tuesday, Jan. 24, 2012. The indictment was unsealed this morning upon her arrest by federal agents at her residence and she is expected to make an initial appearance in federal court later this morning before U.S. Magistrate Judge Dorina Ramos.
According to the indictment, from 2007 through 2008, Lopez worked for a San Antonio, Texas, insurance agency, selling Medicare Advantage insurance plans. These plans provide Medicare beneficiaries with the option to receive their benefits through a wide variety of private managed care plans, rather than through the traditional Medicare program. The indictment alleges Lopez obtained identifiers of beneficiaries through a variety of illegal means and used the identifiers to enroll the beneficiaries in a Medicare Advantage plan offered by Care Improvement Plus – a Baltimore, Md., insurance company – without the authorization or knowledge of the beneficiaries. Lopez received thousands in commissions as a result of the false enrollments.
The indictment further alleges that only a few days after being suspended by Care Improvement Plus, Lopez entered into a sales agent agreement with United Funeral Directors Benefit Life Insurance Company (United), of Richardson, Texas, which offered pre-need funeral contracts allowing insured individuals to pre-plan and pre-fund funeral expenses. According to the indictment, soon after becoming an agent for United, Lopez began enrolling numerous individuals in United’s pre-need funeral insurance policy without their authorization or knowledge. The indictment alleges Lopez used bank account information belonging to unsuspecting United clients, whom she had previously enrolled, to make premium payments on the false policies. Lopez received thousands of dollars in commissions from United in connection with the alleged fraud.
Each count of mail fraud carries a sentence of up to 20 years in federal prison without parole and a $250,000 fine upon conviction. Lopez also faces a mandatory two-year prison term for each count of aggravated identity theft which must be served consecutive to any prison sentence imposed on the underlying charges.
The investigation leading to the charges was conducted by the U.S. Department of Health and Human Services–Office of Inspector General and the U.S. Secret Service. Assistant United States Attorney Greg Saikin is prosecuting the case.
An indictment is a formal accusation of criminal conduct, not evidence.
A defendant is presumed innocent unless convicted through due process of law.
