It's early on a Saturday morning in Southern California and Andres Sanchez is eyeing the doctor who is about to cut into him for no reason. As he reclines on the table, so far from home, for hernia surgery on his perfectly healthy stomach, Mr. Sanchez tries to focus on the $800 he was promised for lying about his condition. Imagine the desperation abject poverty can create for poor immigrant workers trying to survive on $200 a week. Facing those odds, Mr. Sanchez, and 5,000 others like him, became willing pawns in what authorities are calling the most unethical insurance scam ever uncovered.