Insurance Fraud Suspects Aren’t Always What You Would Expect

Insurance fraud is an issue that continually grabs headlines and acts as one of the greatest threats for increased premiums across the full spectrum of products. Customers often don’t see how the practice affects them and mistakenly look at it as a “victimless crime,” when they, in fact, are some of the primary victims. Unfortunately, fraud is an all too common occurrence and companies have to factor such activities in when it comes to setting rates. Also unfortunate is the fact that some of the least likely people can be primary suspects as you’re about to learn in this roundup of insurance fraud activities.


U.S. Marshal Pleads Guilty

U.S. Marshals are taxed with keeping the laws of the country, so they often fly under the radar of suspicion when it comes to insurance fraud activities. But a Marshal in San Antonio, Texas, proved that perpetrators can come from a variety of backgrounds and vocations — even the most unexpected ones.

Claims Journal reports that the Marshal “pleaded guilty to wire fraud relating to an insurance fraud scheme.”

Reynaldo Gonzalez entered his guilty plea Wednesday and “admitted that he filed a fraudulent claim for medical treatment of various fictitious injuries and using a physician’s signature and tax identification number without the doctor’s knowledge.”

Gonzalez’ insurer sent “several checks” to him before authorities were able to close in. He could receive up to 20 years in federal prison and be hit with fines totaling $250,000 when sentenced on April 23.


Prominent Family Facing Charges In $31M Scheme

Claire Risoldi of Bucks County, Pennsylvania, is known for her abilities as a political fundraiser, but authorities now claim that she is one of the ringleaders of a long-running insurance scheme that has defrauded companies of as much as $31 million in helping the family maintain its lavish lifestyle.

Risoldi, 67; her husband, Thomas French, 64; and three other family members are charged with corruption, theft, conspiracy and other crimes related to allegedly inflated insurance claims stemming from a 2013 fire in which Risoldi claims that volunteer firefighters stole $11 million in jewelry.

An additional $20 million in inflated claims is suspected from the fire — monies the Risoldis used to “rebuild their home, rent temporary housing and restore Romanesque murals of the family ‘resplendent in flowing robes gazing down from the heavens,’” according to a grand jury presentment that detailed the allegations.

The fire was the third in a five-year period, raising red flags from insurance fraud investigators.


Former Cubs Pitcher In Hot Water

According to a report from KSBY in California, former Chicago Cubs pitcher Ted Lilly is in hot water for alleged involvement in an insurance fraud scheme that stemmed from his damaging a $200,000 RV, which he did not report until after purchasing insurance on the vehicle. Assistant District Attorney Lee Cunningham said the crimes happened in March of 2014.

“I can tell you that he’s charged with three different felony counts. The first is filing a false insurance claim. The second one is a false statement in support of a claim and the third one has to do with failing to disclose a material fact in connection with an insurance claim,” Cunningham said.

If convicted, Lilly could face up to five years in jail. He reportedly earned more than $80 million throughout his career.


In Summary

Insurance fraud — a “victimless crime” — is actually anything but. Insurers are forced to build losses into the cost of premiums in order to provide coverage, and those additional costs will find their way to the customer. Without such a hierarchy, it wouldn’t be possible to protect one’s home or car or family through an insurance product. The more customers understand this relationship between fraud and rates, the easier it will become to spot insurance fraud as it occurs and root it out before financial loss becomes a major issue.

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