Department-led investigation leads to arraignment of a dozen suspects in disability fraud scheme
News: 2023 Press Release
LOS ANGELES — A California Department of Insurance-led investigation with assistance from the California Department of Justice has resulted in the arraignment of 12 suspects today on over 110 felony counts including conspiracy, insurance fraud, and grand theft for their alleged involvement in a disability fraud scheme which netted the suspects over $450,000 from insurance carriers and over $60,000 from the COVID-19 Relief Program.
Department of Insurance detectives conducted numerous search warrants and interviews and determined the alleged ringleaders, a husband and wife from Rancho Cucamonga, used “shell” companies to apply for short-term group disability policies offered by private insurance carriers and through the COVID-19 Relief Program. They would then recruit individuals to be fictitious employees and would file fraudulent disability claims under those fictitious employees.
“These suspects allegedly used false companies and fictitious employees to take advantage of a system designed to help injured workers,” said Insurance Commissioner Ricardo Lara. “These types of schemes negatively impact consumers and businesses through higher costs. We will continue to work with our law enforcement partners to protect consumers and combat insurance fraud.”
“Crimes against a program like the state’s short-term disability fund, which is designed to provide relief to injured Californians by providing them with financial assistance during trying times, will not be tolerated,” said Attorney General Rob Bonta. “Those who steal from these programs are stealing from the families who rely on them. My office will vigorously pursue anyone who commits fraud against these critical programs.”
The Department of Insurance opened an investigation in April of 2020 after receiving several suspected fraud referrals from multiple insurance carriers claiming numerous individuals applied for disability insurance policies using fraudulent information or filed fraudulent disability claims using fraudulent information.
This alleged fraud scheme resulted in a loss of approximately $458,732 to the insurance carriers. The ringleaders collected most of the profit from the scheme and would give those they recruited a percentage of the proceeds for their participation.
Suspects were arrested throughout the state on Thursday, April 6, 2023, and Friday, April 7, 2023. The Office of the Attorney General is prosecuting the case.
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Led by Insurance Commissioner Ricardo Lara, the California Department of Insurance is the consumer protection agency for the nation's largest insurance marketplace and safeguards all of the state’s consumers by fairly regulating the insurance industry. Under the Commissioner’s direction, the Department uses its authority to protect Californians from insurance rates that are excessive, inadequate, or unfairly discriminatory, oversee insurer solvency to pay claims, set standards for agents and broker licensing, perform market conduct reviews of insurance companies, resolve consumer complaints, and investigate and prosecute insurance fraud. Consumers are urged to call 1-800-927-4357 with any questions or contact us at www.insurance.ca.gov via webform or online chat. Non-media inquiries should be directed to the Consumer Hotline at 800-927-4357. Teletypewriter (TTY), please dial 800-482-4833.
