WEST PALM BEACH, Fla. (WPEC) – Chemotherapy, radiation, and anti-nausea treatments. They can be painful for cancer patients.
A woman in West Palm Beach apparently went through that but then submitted dozens of claims for payment to American Family Life Assurance Company, and got paid more than $37,000, but authorities say she submitted forged medical treatment and progress notes.
According to the report from the Florida Department of Financial Services, Pilar Garcia was known as Marcela del Pilar Ortiz Leal and in June, 2017, she took out a cancer insurance policy with Aflac.
Then, around October, she was diagnosed with breast cancer and began treatments.
Between January and November, 2018, she filed 13 claims for valid cancer-related treatments.
After that, she went four months without filing any claims.
The report from the state says that from March 2019, through Sept. 2021, Garcia filed 63 claims with Aflac for cancer-related treatments that supposedly happened at two facilities, both located at Good Samaritan Medical Center.
Garcia’s legal trouble began in Dec. 2020. That’s when an Aflac special investigator reported her name appeared on a list of policyholders who were potentially involved in an “Excessive Radiation Treatment” scheme.
That meant her account was flagged for a review of her claims, and the special investigator verified those 63 claims were fraudulent.
On Oct. 27, 2021, the special investigator sent a letter of restitution, asking Garcia to pay back the...
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