SANTA ANA, CA - According to the Orange County District Attorney's Office, three defendants were sentenced today on charges of conspiring to defraud American International Group, Inc. (AIG) and another insurance company out of more than $1.4 million by illegally settling liens on Workers' Compensation Insurance claims. Hector Porrata, 46, Moreno Valley, pleaded guilty to a court offer to 50 felony counts of grand theft, 50 felony counts of insurance fraud, and 1 felony count of conspiracy. Poratta was sentenced to eight years in state prison and ordered to pay over $1 million in restitution.
George Martinez, 43, Apple Valley, pleaded guilty to a court offer to 11 felony counts of grand theft, 11 felony counts of insurance fraud, and one felony count of conspiracy. Martinez was sentenced to two years in state prison and ordered to pay over $300,000 in restitution.
Cara Cruz-Thompson, 47, Victorville, pleaded guilty to a court offer to 12 felony counts of grand theft, 12 felony counts of insurance fraud, and one felony count of conspiracy. Cruz-Thompson was sentenced to two years in state prison and ordered to pay over $200,000 in restitution.
A fourth co-defendant, Rene Montes, 42, Riverside, is charged with 59 felony counts of grand theft, 59 felony counts of insurance fraud, three felony counts of tax evasion, and one felony count of conspiracy, with sentencing enhancements allegations for aggravated white collar crime for loss over $1.5 million and $500,000. He has a pre-trial hearing May 28, 2010. If convicted on all counts, Montes faces a sentence ranging from probation up to 108 years and four months in state prison.
When a Workers' Compensation Insurance claim is filed, doctors and hospitals can put a lien on the claim to ensure payment by the insurance company. These doctors and hospitals can negotiate the lien or have a third party negotiate on their behalf. Porrata, Martinez, and Cruz-Thompson negotiated such liens while working at a claims adjusting firm. Montes is accused of also negotiating such liens while working at the same claims adjusting firm with the other three defendants.
Montes is accused of later owning W.C. Surgery Centers in La Habra and W.C.S.C. & Associates in Riverside. Porrata and Cruz-Thompson went to work at a Workers' Compensation Insurance company, Matrix Absence Management. Porrata, Martinez, and Cruz-Thompson all eventually worked together again as Workers' Compensation Insurance adjusters at AIG.
Between August 2003 and January 2006, Porrata, Martinez, and Cruz-Thompson conspired to commit insurance fraud and grand theft by settling claims through the insurance companies with Montes, who is accused of using his businesses for liens he did not have the authority to collect. Montes is accused of sending more than 50 letters to Matrix Absence Management and AIG falsely claiming to have authority through W.C.S.C. & Associates to negotiate, settle, and collect payment on pending liens on behalf of doctors and hospitals. Knowing these claims to be false, Porrata, Martinez, and Cruz-Thompson fraudulently settled Montes' claims and paid him more than $1,170,000 from AIG and $310,000 from Matrix Absence Management. Montes is accused of receiving the stolen funds and failing to file tax returns on his fraudulent income.
On Feb. 2, 2007, AIG received a demand letter from a hospital for payment of an outstanding medical lien, which AIG determined had already been paid to Montes. As a result, AIG conducted an internal audit and discovered that Porrata, Martinez, and Cruz-Thompson were the only three claims adjuster in the entire company to have settled liens with Montes and reported it to the Orange County District Attorney's Office (OCDA) and California Department of Insurance (CDI).
Deputy District Attorney Tom Shultz of the Workers' Compensation Insurance Fraud Unit prosecuted this case.
No comments:
Post a Comment