insurance fraud

Spotlight – Tragedy Produces Crime

Liability cases can be tricky. Worked on a case once that turned from a AOE/COE into a subrogation once we uncovered the cause of death was a faulty support system installed by a 3rd party. Sadly, the death occurred just before Christmas. Another case involved a man who sued a major car maker because their car caught fire due to the man’s DUI influenced wreck. Still another saw a man lose his wife, of fourteen years, and his four children when the SUV exploded.

Yes, the cases are often sad. And sometimes, they include a twist. Like the time a malpractice lawsuit turned into a mafia operation. No joke.

Picture this: man goes into hospital with chest pains. County hospital misdiagnosed him (I’m not sure how they didn’t suspect a heart attack), and he dies. Family sues the country for a few million. I am tasked with checking in on businesses and assets on the deceased and his immediate family.

Here’s where it got weird. Ownership of all the businesses, all of which were involved in medical supplies, were being transferred to family friends. This included all the businesses which should have been owned by the subject’s spouse and children. Nope. Every business was transferred, and even the property deeds were being toyed with.

This case became so confusing I had to generate a data model to show all the relationships and connections between family and friends (including phone numbers, addresses, etc.). I also ended up doing bank searches and spot checks. I found some of businesses even changed their name or registered out of state.

The funny thing? They weren’t asking for more money. No, everything was being done to keep prying eyes away from their books. Allegedly, the entire thing was some sort of mafia racket. I didn’t stay on this case long enough to see it through. I handed over my findings to the county and we all went our merry ways. One of the craziest plot twists ever. Not the most insane though. I’ll leave that story of the vegetable turned real estate mogul for another day.

Spotlight – The Unknown Dad

The legal disputes and drama surrounding the death of a family member never cease to amaze me. One heir search was supposed to be easy: a man married for forty-six years to one woman and four kids. By the time I was done, I located sixteen total children spread across three mistresses in addition to his wife. So yeah, next of kin cases are messy.

This particular case I worked on involved the death of a minor. They weren’t even a teenager yet. The mother, “Jane,” had signed a sworn testimony that she had no idea who the father was. An important thing when it comes to claiming a hefty life insurance policy. Odd as well. Did she really not know who the father was?

I retrieved the birth and death certificate for the minor. Jane had made sure to list the father as “unknown” on both official documents. A geofence didn’t reveal much either. And a sweep of obituaries and memorials gave no mention of the father.

I ran family and probate searches, in addition to a marriage/divorce record sweep, focused on the county Jane presently resided in. She married a man a few years ago, even had more children, but her husband was not the father of the minor in question.

An initial social media search did not provide any further answers. So I kept digging, focusing on Jane’s siblings. And sure enough, one of her siblings posted a memorial video. About eight minutes into watching it, I noticed a 8-10 second clip of a man holding the minor. This man would turn out to be the father.

I went back through Jane’s address history, identified the possible counties she lived in around the birth of the minor, and ran another civi records search. No marriage or divorce records were found, but bingo – a child supper order.

The name of the father was listed on the order. I attempted to contact Child Support, but they are never very cooperative. Instead, I ran a social media on the father, confirmed his social media presence by matching multiple data points, linked him to Jane’s siblings, then reverse engineered his social media profiles so I could find his info on closed source databases.

Jane lived in California. The father was now living on the other side of the country with his wife. He was a registered sex offender (statuary rape between like a 19 year old and a 17 year old). This was likely why Jane thought it wouldn’t be a big deal. And he had been paying child support to Jane for years. In fact, the order was still active. Not only did she know who the father was, she had been receiving monthly checks from him!

So Jane had committed perjury in an attempt to collect all that life insurance. The result, of course, was being charged with insurance fraud. Still, extremely sad that a minor’s tragic death was overshadowed by such pettiness. But such is life.

Spotlight – You Got The Wrong Guy

The feeling hit me as soon as I finished putting in the request. When you have been doing cases as long as I have you learn to act on those gut feelings immediately. It only takes a single hunch to crack an investigation wide open. And in this case, it proved an accused man to be innocent.

So I put the asset and employment searches on hold. I conducted a second, more thorough read of a poorly written police report. The incident was a hit and run. Some damages to a vehicle, but no fatalities. No witnesses. Police looked into the case, but not much had been done. All we had was the license plate of a vehicle and the name (we will call him Jack) and the his alleged address.

The address came back to Military housing. A sweep of the area identified three subjects by the name of “Jack,” but only one had served in the military. A check of his military records showed he served his country for two years. He left the area some 9 months after leaving the military, and moved more than 3,000 miles away. His spouse finished her time in the military just 5 months after he did, and also left the area.

I then uncovered two clues: the vehicle involved in the hit and run had been sold right before Jack left the area. And Jack had bought a new vehicle just a couple months before leaving the area. A vehicle history run on his new vehicle placed that vehicle some 3,000 miles away at the time of the hit and run incident. The history also showed the subject had indeed left the area, and was still the owner of this newer vehicle. Additionally, a vehicle sighting report, in additional to a property deed owned by Jack and his spouse, proved the subject no longer resided in the area of the incident.

I ran the plates of the vehicle involved in the hit and run. I found multiple violations and citings since the vehicle had been last sold with multiple drivers and charges that included not having registration in the vehicle, not having motor vehicle insurance, and not driving with a valid license.

It turns out that Jack had sold this vehicle after leaving the military. His wife and him then moved far away and got on with their lives. However, the people they sold the vehicle to never turned in the paperwork to the DMV. Jack was still listed as the registered owner of the vehicle at the time of the hit and run.

Thankfully, I was able to prove that Jack had no involvement whatsoever with the hit and run. No need for an asset and employment check. He won’t be facing criminal charges or a lawsuit. Instead, we were able to narrow the field of suspects down to three individuals, making the lives of field investigators that much easier.

Morale of the story? Work on your discernment. Go with your gut. Don’t do something if it doesn’t feel right.

Case Study – Intelligence / Investigative Analytics

Over the last seven years, and for more than 12,000+ investigative hours, I’ve worked as a intelligence/investigative analyst. I use both intelligence and investigative because the position goes by either.

Technically, I’m an All Source Analyst because I use both open (OSINT) and closed source data points. An intelligence analyst researches, gathers, and evaluates data from a variety of sources. They specialize in data mining. An investigative analyst works on, you guessed it, investigations.

Typically, there are three divisions: military, law enforcement, and insurance. Often, we use similar databases but with different levels of security clearance. Law enforcement is more concerned with digital forensics and cyber investigations. Military locate and track terrorists. Insurance investigates claims. All three have similar skill sets: we are cyber sleuths. It should be noted that there are also Cyber Security Threat Analysts that are also similar (they search systems and networks).

The insurance side of things deals a lot with insurance companies and law firms, and often works alongside law enforcement. Some of the cases I’ve worked on include money laundering, rape, assault, kidnapping, and shootings. Several of them have gone international (Mexico, Spain, Canada, Guatemala, etc) , and have included all forms of insurance: liability, work comp, property loss, FMLA, and life.

Before I continue, it should be noted that a background investigator is not the same as an analyst. Yes, I may do a simple social media sweep or a pre-employment search, but that’s the extent of what a background investigator does. They collect a bunch of data, but make little to no attempt at evaluating it. They don’t go beyond the confines of a search engine. Additionally, a copy service retrieves documents such as court records, birth certificates, and camera footage from an intersection, but that is only the “other” duties of my job function, and not what I do the majority of the time.

So, what do I do? I piece puzzles together in order to paint a clearer picture. I work on skip traces, SSN traces, heir searches, asset and business searches, employment checks, social media archives (which may include metadata) and criminal/civil checks, and a host of other case types. I launch bank account searches, comb through DMV records, and run vehicle sighting reports. I might triangulate the location of a cell phone or create a family tree in Ancestry.

Yep, I’ve read thousands of police reports, traffic incident reports, birth certificates, property deeds, property transfer detail reports, vehicle titles, death certificates, autopsies, bankruptcy documents, articles of organization and incorporation, statements of info, and marriage and divorce records. I conduct geofences, match data points, and watch body-cam and surveillance footage. I then conclude my findings by compiling a legal document for court purposes.

My toolkit is vast. It includes a host of software and online databases. And it’s not something one ever truly masters. You’re always learning, adapting to some new trend or security feature, and uncovering new methods for solving cases. You’re on the frontlines in combating the $1 trillion a year industry known as fraud. And rarely are two days alike.

Your coworkers have no idea what it is you do. The certificates you get are often the same ones military and law enforcement receives. And you’re even eligible to test for and receive a PI license! It’s a job that includes lots of tech, sometimes being on call for a court appearance, and is rewarding in and of itself. I mean, I get to work on some really interesting cases and see things few others can ever testify of. We see a lot, learn a lot, and the feeling you get when you crack a case…it’s amazing.

So whether it’s a dude claiming to be a vegetable who is using dummy LLCs in a real estate pyramid scheme, another dude who claims to be broke to sneak his way out of lawsuits while he liquids his assets, transferring them to Canada where he happens to be a multimillionaire, or it’s finding a mother pretending not to know the identity of the father so she can collect all the life insurance on her deceased toddler, the cases are never the same.

Eight years ago I didn’t know this position even existed. I was experienced in marketing, sales, writing, customer service, and project management. I started out in data entry, did some editing, and then stumbled into a super fun and wildly different day job. It’s perfect for the writer and mystery lover in me. And I can’t wait to take it to the next level.

Case Study – Missing Child

Over a career spanning 7+ years and 12,000+ investigative hours, still the toughest case I ever worked on was that of a missing child – my own daughter. It was a case I worked on for more than a decade, spanning half a dozen states and a multitude of slammed doors, a broken justice system, and a shattered heart.

My investigation started before I became a intelligence & investigative analyst. It began shortly after my soon to be ex-wife informed me our relationship was over and sent me to the curb. I was 2,000+ miles away from home, having just moved from California to the middle of Misery…I mean Missouri. I literally went from a sunshine paradise right into a frozen tundra. Of course, I had done it for love, only to be betrayed and discarded.

My first experiences with the family court system in Missouri took place during the divorce proceedings. One thing was made painfully obvious and clear to me by my attorney: the courts will not like you simply because you are male. Discrimination in family court is not only an accepted reality, it goes almost entirely unchallenged across the country. The media won’t cover it. Law enforcement ignores it. And in family court, one person, the judge, has absolute authority and control.

Without going too much into detail, over the course of the next several years, I dealt with a mother who domestically kidnapped my child. Because the mother was the one who kidnapped the child, police departments in multiple states refused to allow me to file a report. It was a domestic issue, they told me. With no police report, I could not file a report with the FBI.

None of this stopped child support from collecting. In fact, they were emboldened by it. They often collected between 60-70% of my pay, making money off the interest. I was forced to pay for medical insurance my daughter had no way of using. Long story short, there were times I lived on less than a $1k a month. However, I never gave up. After several years of wondering the Midwest, I came back to California and stumbled upon a job in investigations.

I quickly learned the ins and outs of the insurance industry. From the different kinds of insurance, to understanding fraud, and every aspect of my company’s firm. I set records for speed and accuracy in their data entry department. Before long, I worked at nearly every position at the place and won a nice employee of the year award.

Using my newfound resources, not to mention years of dealing with courts from various states, I searched for my little girl across the internet. And man, the tools I had were incredible. OSINT. Digital forensics. Still, there’s a reason so few missing children are found. It’s rough. And even looked hopeless. Law firms had offered to take my case, but only for a $25k or more retainer, and it would be up to me to find her, with nothing guaranteed.

The case was blown open when I came across a random video of my daughter…now much older…surfing not far from where I lived. I was stunned. She had been not too far from me. See, I had tracked her from Missouri to Oregon to Washington to Utah, all while living in Illinois, Indiana and Alabama. This bread crumb led me to a family court case involving one of my ex’s ex-husbands. I got hold of the court documents…and was floored.

My daughter had been abandoned by her mother and was living with her former stepdad. To make matters more complicated, the former stepdad had petitioned for guardianship in probate court. It was now or never. I didn’t have the money to afford star studded attorneys. But I had truth on my side, and over a thousand pages of evidence I had collected for the better part of a decade.

I won the probate with ease. The case was then sent to family court. And yes…I could have won that too. The court investigator was stunned by the amount of work I had done. The sheer volume of evidence and research…she hadn’t even seen that on criminal cases. But time was against me. It had taken me far too long to find her. I was given a choice: exact justice and hurt my daughter, or forgive and let her go. But by letting her go, she could heal. By pressing forward, I would cause damage to her.

This is a long case study, I know. It was the most difficult case of my life. I used every available resource. I proved my case beyond any reasonable doubt. I actually had two massive law firms opposing me and both were bewildered. In the end, I chose the option of forgiving and allowing my little girl that opportunity to heal. Yes, it breaks my heart. But it would have broken it more to see her have to go through anymore pain. I kick myself for being too late, but there’s nothing more I could do.

Morale of the story? Investigations often hinge on that one little clue, that overlooked detail, that tiny bread crumb. And sometimes life won’t be fair. The waves will be a bit rough. For this, I’m thankful for my relationship with Jesus. He’s my crutch, my wheelchair, my entire hospital. Yes, life can be dark sometimes. But never lose hope. Keep pressing, keeping digging, keep climbing. Upwards and onwards. Don’t become a prisoner of your past, allowing bitterness to chew away at your dreams. Forgive. Move on. And never, ever, ever give up. One day at a time, friend.