Woman gets 30 months for Culinary Union health program fraud

By Steve Kanigher

Friday, May 28, 2010 | 11:58 a.m.

U.S. District Judge Lloyd George sentenced a California woman Thursday to 30 months in prison for defrauding the Culinary Union’s health care insurance program, Nevada's U.S. Attorney Daniel Bogden said today.

Ana Bertha Acosta, 40, of Dulzura, Calif., also was ordered to pay $959,735 in restitution. She pleaded guilty on Feb. 16 to three counts of health care fraud.

From June 2000 to June 2007, Acosta and several co-schemers submitted fraudulent health care claims to the Culinary Union’s health care insurance program by representing that union members had obtained emergency medical services in Mexico, when they actually received cosmetic procedures such as breast augmentations and “tummy tucks.” The union’s insurance program does not provide coverage for cosmetic surgeries, unless they are medically necessary.

The investigation was initiated in 2006 to determine whether Las Vegas insurance providers were being targeted for fraudulent medical claims by Mexican medical providers.

Investigators found that the Culinary Union’s health care insurance program, which provides medical insurance services to at least 50,000 participants in the hospitality industry in the Las Vegas area, had been billed roughly $4.9 million for “out of country” claims from January 2002 through February 2006. Investigators also found that the “out of country” claims were almost entirely from Mexico.

The majority of the claims were for emergency procedures in Mexico. When investigators began interviewing a number of the patients, they were told that the insurance claims were fabricated and that they had actually had cosmetic surgery in Mexico, not emergency services.

Acosta’s sister, Rebeca Acosta, 47, was also charged in the scheme and was released on bond following her first court appearance. Rebeca Acosta failed to appear for subsequent court hearings and a warrant was issued for her arrest. She remains a fugitive.

The cases are being investigated by the Office of Inspector General for the U.S. Department of Labor and the U.S. Postal Inspection Service. They are being prosecuted by Assistant U.S. Attorney Crane Pomerantz.