Two California and two Las Vegas women have been charged with organizing, and participating in a scheme to defraud the local Culinary Union’s health insurance program. The women submitted claims for unauthorized cosmetic surgery procedures performed on union members in Mexico, according to U.S. Attorney Greg Brower of Nevada.

Rebecca Acosta, 46, of Chula Vista, Calif., was indicted Wednesday by a federal grand jury on three counts of mail fraud. Acosta was arrested April 14 in San Diego and released Wednesday on a $150,000 bond. Three other women have been charged by criminal complaint for their involvement in the scheme, Brower said. Ana Bertha Acosta, 39, of Dulzura, Calif., was arrested Monday in San Ysidro, Calif., and Sara Casales, 47, of Las Vegas was arrested April 14 in Las Vegas. Both are charged with health care fraud and aiding and abetting. Lucia Solano, 49, of Las Vegas, also arrested April 14 in Las Vegas, is charged with making false statements to investigators.

In 2006 federal investigators initiated an investigation to determine if Las Vegas insurance providers were being targeted for fraudulent medical claims by Mexican medical providers, according to court records. The investigators found that the Hotel and Restaurant Employees International Union Welfare Fund, also known as the Culinary Fund, which offers medical insurance to at least 50,000 people in the hospitality industry in Las Vegas, had been billed about $4.9 million for “out of country” claims from about January 2002 to February 2006. Those “out of country” claims were almost entirely from Mexico, investigators discovered. Most 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. The Culinary Fund does not provide coverage for cosmetic surgeries, unless they are medically necessary, such as breast reduction and certain types of rhinoplasty.

Rebecca Acosta, the prinicple suspect, and her cohorts allegedly devised a scheme to defraud the Culinary Fund of money through submitting false health care claims. Acosta and the others met with prospective patients at a Summerlin residence and elsewhere for consulting on cosmetic surgeries, court documents say.

Acosta told the patients that she would bill the Culinary Fund for the cosmetic surgery, such as breast augmentations or “tummy tucks,” even though such procedures were not covered through the insurance program. She told patients that she would make it appear as if the patient suffered an unexpected injury in Mexico and had received emergency medical care, and then allegedly made arrangements for the prospective patients to receive a cosmetic procedure at a Tijuana, Mexico, clinic. She followed by charging the patients a fee in addition to any reimbursement they would receive from the Culinary Fund. Acosta instructed each patient not to disclose the true nature of the treatment they received in Mexico.

Once the patients received treatments in Tijuana, Acosta and the others submitted false and fraudulent claims to the Culinary Fund, requesting reimbursement for emergency medical services, even though they knew that the patients had actually received breast implants and body contouring surgery, court documents state.

Between September and October 2005, Acosta allegedly submitted three fraudulent claims for reimbursement for emergency procedures performed on three patients and the Culinary Fund paid more than $42,000 on the claims. If convicted, Acosta faces up to 20 years in prison and a $250,000 fine on each count; Ana Bertha Acosta and Sara Casales face up to 10 years in prison and a $250,000 fine each; and Lucia Solano faces up to five years in prison and a $250,000 fine.

The case is being investigated by the Office of Inspector General for the U.S. Department of Labor, and the U.S. Postal Inspection Service. It is being prosecuted by Assistant U.S. Attorney Crane Pomerantz.

“This indictment sends a stern message to those medical providers that defrauding union health and welfare benefit plans by filing fraudulent claims will not be tolerated by my agency,” said Daniel R. Petrole, deputy inspector general for the U.S. Department of Labor. “We are firmly committed to working with other law enforcement agencies to investigate this type of crime.”

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Our second “Cosmetic Surgery FAQ” post in the series, we take a closer look at Tummy Tuck surgery. A plastic surgery mainstay, but often overlooked for other less invasive procedures such as liposuction, “abdominoplasty” deals with removal and/or tightening of excess skin and fat in the abdominal region. Today, we take a look at a couple of the most common questions that prospective body contouring patients have, when considering a tummy tuck.

Q. Is getting a tummy tuck the right decision for me?

A. Choosing to undergo an abdominoplasty or any kind of body contouring surgery is a major decision. This is due in no small part to the extensive and invasive nature of the surgery itself, the risks and side effects involved and the amount of recovery time the surgery typically requires. However, many thousands of men and women choose the procedure every year to get rid of unwanted fat and sagging skin in their mid-section. A consultation with a qualified tummy tuck surgeon will make sure that you are thoroughly informed about the procedure, its risks, your alternatives, and whether a tummy tuck is right for you.

Q. What should I expect before, during and after my tummy tuck surgery?

A. Your cosmetic surgeon will provide a thorough and unique list of things for you to do to prepare for your surgery. Most of what will be included on the list are medications and activities to avoid during the two weeks prior to and after the surgery in order to minimize risk during the surgery itself, and during your recovery period. For example, if you smoke, you will be strongly advised to quit for two weeks prior to and after surgery, as smoking significantly slows the healing process. There are a number of medications, vitamins and supplements that should be avoided prior to surgery that your surgeon will discuss with you. Upon his or her asking, full disclosure with your doctor about any and all medication is the best way to anticipate and hopefully avoid any post-operative problems. If you are in generally good health and lead a healthy lifestyle, then you should not expect to have to make any significantly drastic changes in the weeks leading up to your surgery.

Most abdominoplasty surgeries are done in a hospital with the patient under general anesthetic. This being said, you will be unconscious during the surgery itself, so you should not expect to experience any discomfort. Typically, abdominoplasty lasts anywhere from two to four hours.

A tummy tuck is a very involved, invasive procedure that requires the patient to spend a few days in the hospital afterward. You will be given pain medication during and after your time in the hospital. You will also be advised to begin walking around and doing light exercise as soon as possible after the surgery in order to prevent the formation of blood clots in your legs. Expect a week to pass before being able to walk normally and without discomfort.

Q. What about scarring?

A. You should expect to have a permanent or near-permanent scar. The length of the scar or scars will depend on how extensive your surgery is. Tummy tuck scars generally run from hip to hip, across the lower abdomen. Extra attention is given to the placement of the incisions to ensure that your scars will be minimal and inconspicuous. Typically, the incision site is well-hidden beneath undergarments and swimming attire.

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