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San Juan Medical Doctor Convicted Of Scamming AFLAC Out of $8 Million

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SAN JUAN – Dr. Aníbal Pagán-Romero, a general practitioner with a clinic in Quebradillas, Puerto Rico, was found guilty Monday on all counts of an 82 count indictment charging 21 conspiracies and 61 individual counts of mail fraud from a scheme to defraud the American Life Assurance Company of Columbus, Georgia, better known as AFLAC, according to the U.S. Attorney’s Office.

The conviction is the result of a lengthy investigation undertaken by the Federal Bureau of Investigation into multiple insurance fraud schemes in the Western region of Puerto Rico which resulted in the arrest and prosecution of hundreds of individuals, the U.S. Attorney’s Office said.

Pagán-Romero was charged with 35 patients for perpetrating a scheme where he fraudulently signed AFLAC accidental insurance claim forms without examining the patients.

The evidence presented at trial showed that from 2004 through 2009 Pagán-Romero caused an approximate loss of $2,000,000 to AFLAC through the claim forms filed with the other 35 co-defendants and approximate loss of $6,000,000 for all the AFLAC claim forms filed under Pagán-Romero’s signature. The 35 patients who were charged alongside Pagán-Romero had pled guilty to the charges prior to the commencement of trial.

The three-week trial before the U.S. District Judge Gustavo Gelpí included the testimony of three of the doctor’s employees and four patients who indicated that Pagán-Romero personally instructed them to submit the documents for his signature without examination.

The evidence also showed that the scheme had grown so large and lucrative that Pagán-Romero had to hire two employees to do data entry full time in order to generate the thousands of AFLAC claim forms submitted for reimbursement under his signature.

The evidence presented at trial revealed that Pagán-Romero would have been capable of pocketing $975,000 in cash during the five year conspiracy for signing the AFLAC claim forms at $10 per form.

Pagán-Romero is exposed to a term of imprisonment of up to 20 years for his crimes. The sentencing hearing is scheduled for January 19, 2016 and the doctor was remanded to the custody of the U.S. Marshals.

“This conviction marks yet another victory in our fight against fraud in Puerto Rico,” said Rosa Emilia Rodríguez-Vélez, U.S. Attorney for the District of Puerto Rico. “I thank our team of prosecutors and our federal law enforcement partners for the teamwork they showed in leading us to a successful outcome today.”

The case was prosecuted by Assistant U.S. Attorneys Dennise Longo and Julia Díaz-Rex.

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The Author

John McCarthy

John McCarthy

John McCarthy has been reporting on the U.S. Virgin Islands and the Caribbean region since 1989. John's articles have appeared in the BVI Beacon, St. Croix Avis, San Juan Star and Virgin Islands Daily News. He is originally from Detroit, Michigan.

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