Sex Work Health Insurance Claims Lead to Fraud Fees

Department of Justice (DOJ) he is charging the woman on a long-term climate plan: from 2017 to 2021, they paid for health insurance provided to port workers in California’s “medical facilities”.

Sara Victoria, the “leader” of the scheme, recruited women through Long Beach clubs and sent them to provide services at her three chiropractic and acupuncture businesses. Federal prosecutors are also charging eight other people, seven of them dock workers, who allowed him to make false claims to the International Longshore and Warehouse Union-Pacific Maritime Association (ILWU-PMA) health plan in exchange for sex.

According to her confession, Victoria paid for the health insurance plan – which provided medical care with no deductibles or out-of-pocket costs – chiropractic and physical therapy using the names of dock workers, or the names of their relatives. over $2.1 million in false positives. In return, Victoria paid money to support members of the ILWU-PMA plan, and managed the project through correspondence, court documents say. In the end they collected about $550,000.

ILWU said in a press release that it has “condemned allegations of fraud against its ILWU-PMA Welfare Plan by seven and three welfare workers.”

“Our union is proud to have negotiated the health benefits with our employers that we believe all Americans deserve. We will not tolerate fraudulent use of our union benefits that long-haul workers have fought for, and in some cases died for, over the past 90 years. ,” said ILWU Coastal Committee, Frank Ponce De Leon in a statement.

Victoria pleaded guilty to using someone else’s personal information without her consent to make fraudulent payments, and was charged with “conspiracy to commit medical fraud and grand larceny.” The DOJ has said that if Victoria pleads guilty, she could face up to 12 years in federal prison.

Another defendant is Cameron Rahm, a coastal resident, ILWU member, and alleged client of Victoria businesses. The DOJ says he agreed to make false statements and lied to FBI agents about it.

This is not the first time that the longshoreman’s union has entered into a fraudulent insurance claims system.

In 2019, another ILWU-PMA plan chiropractor, Darren Hines, pleaded guilty to medical fraud. He billed the treatment plan under another provider’s name for services that were not medically necessary.

In 2016, David Gomez and Sergio Amador was charged with mail theft by operating surgeries that paid ILWU-PMA plans for services that were not provided or were medically necessary. Again, this was mostly done through chiropractic services.

Gomez and his partner opened hospitals and created medical management companies that sent them money from the hospitals, and paid ILWU members to use their hospitals. Again, they used fake signatures and names of the ILWU family to claim fraud in the scheme. Gomez made about $3 million from the scheme, and was sentenced to 20 years in prison.

In 2013, fraudulent claims to the same system of union benefits has contributed to the backlog of more than 100,000 claims. Delays in filing claims with the plan administrator mean that other workers’ health claims go to the grant. This led to protests by union members and job cuts.

  • Sophie Putka is a business writer and researcher for MedPage Today. His work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. He joined MedPage Today in August 2021. Follow up