Please note: As of January 20, 2021, information in some news releases may be out of date or not reflect current policies.
California Dockworkers Union Member Sentenced After U.S. Department of Labor Uncovers Healthcare Fraud Scheme
LOS ANGELES, CA – After an investigation by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA), the U.S. District Court for the Central District of California has sentenced Sergio Amador – a member of the International Longshore and Warehouse Union (ILWU), Local 13 – to 12 months and one day in prison and ordered him to make $201,000 in restitution for defrauding the union’s Welfare Plan.
Amador is the second of two members of the ILWU to be sentenced. In 2017, David Gomez was sentenced to 41 months in prison and also ordered to make $201,000 in restitution.
EBSA’s investigation found that Amador and Gomez opened two clinics in Long Beach and San Pedro, California, under the name Port Medical and then submitted more than $250,000 in fraudulent medical claims to the ILWU plan for chiropractic services that were not provided or were not medically necessary. The pair provided instructions to Port Medical massage therapists on how to maximize billing and make services appear medically necessary.
Investigators also found Amador and Gomez created medical management companies that they used to receive funds generated by the clinics to pay themselves, and to pay incentives to ILWU members in exchange for visiting and promoting Port Medical.
“The U.S. Department of Labor is committed to ensuring that employee health benefits are not abused,” said Employee Benefits Security Administration Regional Director Crisanta Johnson, in Los Angeles. “Fraudulent healthcare schemes such as these victimize health plans and can cause irreparable damage to the security of the benefits those plans provide to hardworking families.”
EBSA, the Department’s Office of the Inspector General, and the Federal Bureau of Investigation jointly investigated the case; and the U.S. Attorney’s Office for the Central District of California prosecuted.
Employers and workers can reach EBSA toll-free at 866-444-3272 for help with problems related to private sector retirement and health plans. Additional information can be found at http://www.dol.gov/ebsa