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By Shawn Raymundo
One San Clemente man and 4 others have been charged in connection to an insurance coverage fraud scheme that trafficked a whole lot of out-of-state substance abuse sufferers to remedy amenities in Orange and Riverside counties as a way to acquire about $12 million in falsified insurance coverage claims.
Reiner Nusbaum, 54, of San Clemente; Jeremy Ryan, 42, of Orange; Daniel Reaman, 41 of Mount Rainer, Maryland; Richard Roberts, 61, of Stockton; and Michael Castanon, 56, of San Juan Capistrano had been charged final week on suspicion of a number of felony counts, together with insurance coverage fraud, cash laundering and conspiracy, in keeping with a joint press release from the California Division of Insurance coverage and Orange County District Lawyer’s Workplace.
“With no regard for the substance abuse sufferers who needed and wanted remedy, this ring trafficked and used them to steal from insurance coverage firms to line their very own pockets,” Insurance coverage Commissioner Ricardo Lara stated within the June 18 press launch.
Based on court docket filings, the DA’s workplace alleges that the 5 males, together with a number of others, devised a scheme during which a mass media advertising marketing campaign was used to entice shoppers from throughout the nation to get free substance abuse remedy in Southern California.
Beneath companies and different entities that the alleged conspirators ran, they signed up shoppers for medical insurance by means of Well being Web, which had strict residency and open enrollment necessities, in keeping with the DA’s complaints.
To bypass these necessities, gross sales representatives had been instructed to falsify the shoppers’ insurance coverage purposes through the use of their very own native house addresses in change for a $300 kickback per utility.
“Advertising agreements” had been additionally allegedly made between the businesses and 17 substance remedy facilities in Orange County and different areas in Southern California. The agreements offered that the firms would get a kickback of the insurance coverage cash for every affected person referred to that facility.
Based on the complaints, greater than 440 folks had been trafficked into Southern California below the scheme, producing about $60 million in fraudulent medical insurance claims and paid out roughly $12 million.
“Remedy is among the most elementary phases in restoration for individuals who search and need assistance. These schemes goal and exploit weak folks at a time once they need assistance probably the most,” Orange County District Lawyer Todd Spitzer stated within the launch. “The Orange County District Lawyer’s workplace will proceed to ship a robust message in opposition to fraudsters and the misleading ways that exploit remedy providers by prosecuting these circumstances to the fullest extent of the regulation.”
Based on the DA’s workplace, the 5 people might face jail phrases between 12 years, eight months and 21 years, 4 months for his or her alleged involvement within the fraud ring.
Shawn Raymundo is the town editor for the San Clemente Instances. He graduated from Arizona State College with a bachelor’s diploma in World Research. Earlier than becoming a member of Picket Fence Media, he labored as the federal government accountability reporter for the Pacific Each day Information within the U.S. territory of Guam. Comply with him on Twitter @ShawnzyTsunami and comply with San Clemente Instances @SCTimesNews.