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Alleged Multi-Million Insurance Fraud

By: Jo Ciavaglia – Bucks County Courier Times » 1/25/2015 » Articles, Insurance Fraud

That insurers paid what a grand jury says were suspicious and fraudulent claims doesn’t surprise private investigator Marc Bourne, of Know It All Intelligence in Bensalem.“When you are dealing with some of the national insurance companies, they are handling thousands of claims on a daily basis. When it comes down to fraud, they’d rather pay out then go through a lawsuit,” he said.While there are national databases in which insurance companies can research prior losses and claims, most insurance adjusters are simply too busy to take the time to dig into each and every claim, Bourne said, adding such databases to detect red flags in claims didn’t exist 20 or 30 years ago.

“As long as someone can give you the documentation that is needed it’s more a formality,” Bourne said. “It’s not until something in a large amount that will open their eyes to someone being greedy.”But what is considered a “large amount” is in the eye of the policyholder, Bourne added.While $20 million sounds like an astronomical amount, among very wealthy clients, it’s a drop in the bucket, he said.

“It’s not like they lived in a townhome and they’re claiming $2 million in jewelry,” Bourne said. “I don’t think it’s unrealistic. We see it as $20 million in losses, but these were considered high-profile clients of AIG.”

Bourne said the Risoldis raised suspicion after the firefighters were accused of stealing jewelry following the 2013 fire. That led to the insurance investigation and the attorney general’s involvement, he said.

“It’s very easy to commit insurance fraud in general, but do you want to take the risk of getting caught? Most people don’t want to do that,” he added. “I really think this (Risoldi) investigation has legs. It’s not over.”

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