Jacobi Journal of Insurance Investigation

The Jacobi Journal

of Insurance Investigation​

Unveiling the truth behind insurance claims.
Protecting integrity in every investigation.

Florida Grand Jury Finds No Criminal Activity in COVID Vaccine Development, but Raises Concerns

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COVID Vaccine Development: A Florida grand jury, convened at the request of Governor Ron DeSantis, has found no criminal wrongdoing in the development of COVID-19 vaccines. The grand jury’s report, unsealed on Tuesday, concluded there was no evidence of criminal activity. However, it did raise significant concerns about the process of vaccine development and safety monitoring in the U.S. Key Findings and Policy RecommendationsWhile the grand jury did not uncover criminal actions, it highlighted serious issues with the vaccine process. As a result, the grand jury recommended increasing transparency in clinical trials and banning pharmaceutical advertisements. The CDC has defended the COVID-19 vaccines, emphasizing that they underwent rigorous safety checks. Even after FDA approval, these vaccines continue to be closely monitored to ensure safety. Public health experts note that the vaccines are effective in preventing severe disease, hospitalization, and death, with only rare serious side effects. DeSantis Requested Investigation Ahead of Presidential BidGovernor DeSantis initiated the investigation in 2022, aiming to challenge pandemic restrictions and gain national attention. He suggested that the probe could help hold wrongdoers accountable and provide more information from pharmaceutical companies on the vaccines and their potential side effects. Florida’s statewide grand juries typically focus on criminal activities and systemic issues, often issuing policy recommendations. Past investigations have addressed topics like immigration and school safety. For more details on the Florida grand jury’s findings and COVID vaccine development, visit Jacobi Journal. You can also read the original report from AP News.

Faith-Based Fund with $24 Billion in Assets Influences Corporate Policies in America

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Jim Lake (Photo by Margaret Albaugh/Bloomberg) Faith-Based Fund. Jim Lake, a devout Christian from Washington state, recently redefined his investment strategy. Guided by a financial adviser, he moved his portfolio into faith-oriented funds, including those managed by GuideStone Funds. This Texas-based firm, founded over 100 years ago, manages about $24 billion in assets and serves primarily Southern Baptist retirees. It has also gained traction among new faith-driven investors like Lake and his wife. The Rise of Faith-Based Investment Coalitions GuideStone is part of a growing coalition of conservative Christian investors. These investors are using their shareholder influence to challenge corporate practices, such as supporting Pride events or reimbursing employees for abortion-related travel. They are also confronting banks accused of closing accounts based on political or religious views. Will Lofland, who leads shareholder advocacy at GuideStone, estimates that half a trillion dollars are invested in conservative faith-based funds. This influence extends across private funds, state pension funds, and more. Key players in this coalition include Inspire Investing, the leading faith-based ETF manager, as well as Republican state treasurers and organizations like Alliance Defending Freedom. Faith-Based Fund The Growth of Faith-Based Funds While faith-driven investing has been around for decades, conservative faith-based funds are gaining momentum. This trend has been fueled by the rightward shift in U.S. politics and a growing resistance to diversity, equity, and inclusion (DEI) programs. More everyday investors are showing interest in faith-based funds. Tim Macready of Brightlight, an advisory firm, notes that assets in these funds surpassed $100 billion last year. Over three years, net inflows grew by 12%. Inspire Investing alone saw a net gain of $334 million in assets last year. GuideStone’s Advocacy and Future Plans GuideStone has expanded its role beyond managing Baptist church pensions. The firm is now actively engaging in shareholder advocacy. As progressive groups have ramped up shareholder proposals, GuideStone has voted its shares to reflect its values. In late 2023, GuideStone supported a proposal asking Microsoft to report on compensation gaps related to reproductive and gender dysphoria care. Although the proposal received only 1% of votes, Lofland stressed the importance of building a larger coalition to increase their influence. Looking ahead, GuideStone plans to focus on the issue of “debanking” in 2025. This refers to the practice of financial institutions closing customer accounts based on perceived risks related to legal or reputational concerns. GuideStone intends to press financial institutions on this issue to protect religious freedoms in the financial sector. For more in-depth analysis of faith-based investing and its impact on corporate America, visit JacobiJournal.com. Additional information on this topic can be found in the original report by Bloomberg.

Former Sewerage & Water Board Employee Arrested for Workers’ Compensation Fraud

Former Sewerage & Water Board Employee Arrested for Workers’ Compensation Fraud

The Louisiana Bureau of Investigation (LBI), under Attorney General Liz Murrill, has arrested Ederik Trask, a former employee of the Sewerage & Water Board of New Orleans. Trask, who resides in Metairie, is accused of workers’ compensation fraud. Specifically, he allegedly misrepresented his employment status while receiving benefits. Complaint and Investigation On August 27, 2024, the Sewerage & Water Board formally complained to the LBI, alleging fraudulent activity by Trask. Investigators soon discovered that Trask had been working for a rideshare company while collecting workers’ compensation benefits. This dual employment, however, violates Louisiana law, which mandates truthful reporting for benefit claims. Sewerage & Water Board Employee Legal Action Taken by Sewerage & Water Board After gathering sufficient evidence, LBI Special Agents quickly obtained an arrest warrant for Trask. He is now charged under Louisiana Revised Statute 23:1208 C.1, which forbids false statements about claims exceeding $10,000. Subsequently, on December 20, 2024, Trask surrendered at the Orleans Parish Jail. There, authorities arrested and booked him without any issues. Ongoing Investigation The investigation is ongoing, as authorities continue to examine the details surrounding the alleged fraud. Meanwhile, the Louisiana Attorney General’s Office emphasizes its commitment to holding individuals accountable for abusing public resources. Consequently, they are determined to maintain the integrity of the workers’ compensation system. For updates and in-depth reporting on similar cases, visit Jacobi Journal.

Lifetime-Banned Fraudster Faces New Charges in $100M Workers’ Compensation Scheme

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Lifetime-Banned Fraudster: In a stunning development, a man previously banned from California’s workers’ compensation system for life has been charged with orchestrating a fraud scheme that racked up nearly $100 million in fraudulent claims. David Fish, alongside a San Diego-based neurosurgeon and two other alleged co-conspirators, faces 13 felony counts, including insurance fraud and conspiracy. The Alleged Scheme Lifetime-Banned Fraudster: David Fish, 55, of Laguna Niguel, collaborated with Martin Brill, 78, Robert Lee, 61, and Dr. Vrijesh Tantuwaya to form Southern California Injured Workers (SCIW), a management company providing medical services. They also created a medical group, Injured Workers Medical Group, where Dr. Tantuwaya acted as CEO. Through this network, SCIW reportedly steered patient referrals to a limited group of providers who agreed to pay illegal referral fees. These services ranged from diagnostic testing to prescriptions from compound pharmacies. Between 2020 and 2023, the defendants allegedly billed workers’ compensation insurers close to $100 million, funneling profits from unlawful referrals back into the network. Charges and Potential Penalties The Orange County District Attorney’s Office charged the group following a three-year investigation. The 13 felony counts include violations of labor laws, conspiracy statutes, and insurance fraud regulations. If convicted: Deputy District Attorney Kelly Albright of the Insurance Fraud Unit is leading the prosecution. Ongoing Issues in Workers’ Compensation This case highlights the challenges California’s workers’ compensation system faces in combating fraud. Illegal schemes not only drain resources but also harm injured workers who depend on the system for proper medical care and fair compensation. For more insights into legal developments and their implications, visit JacobiJournal.com. Source: Orange County District Attorney’s Office Read more from the official source here.

West Haven Recovers $1 Million in Stolen COVID Relief Funds

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Stolen COVID Relief Funds: The city of West Haven, Connecticut, has secured more than $1 million in reimbursement from its insurance provider after two city employees embezzled federal pandemic relief funds three years ago. Swift Action Leads to Recovery of the Stolen COVID Relief Funds Former state Rep. Michael DiMassa and John Bernardo orchestrated a scheme that defrauded West Haven taxpayers of $1.2 million. In response, Mayor Dorinda Borer acted swiftly to recover the stolen COVID-19 funds, which resulted in a $1.2 million settlement with The Hartford Financial Services Group. According to The Hartford’s fidelity crime claims division, after subtracting the $79,177.98 received in court-ordered restitution and a $100,000 deductible, the insurance will cover a net loss of $1,037,363.82. “This is a huge victory for our taxpayers,” Mayor Borer stated. Details of the Fraud Authorities arrested DiMassa, 32, on October 20, 2021, and he pleaded guilty on November 1, 2022, to three counts of conspiracy to commit wire fraud. In May 2023, a court sentenced him to 27 months in prison, followed by five years of supervised release. Additionally, he must perform 100 hours of community service and pay $856,844.45 in restitution. Similarly, Bernardo pleaded guilty on June 14, 2022, to one count of conspiracy to commit wire fraud. By March 2023, he received a 13-month prison sentence and was ordered to pay $58,927.25 in restitution. How the Schemes Unfolded DiMassa, serving as an administrative assistant to the West Haven City Council, had the authority to approve COVID-19 relief funds for reimbursement. Between July 2020 and September 2021, West Haven received $1,150,257 in CARES Act funds. Exploiting this role, DiMassa submitted fraudulent invoices for services and goods that were never provided. One scheme involved Compass Investment Group, LLC, a company DiMassa formed with Bernardo. They fraudulently billed the city $636,783.70 for consulting services that were never performed. Court documents revealed that DiMassa withdrew large sums of cash from the Compass account, which he used for gambling at Mohegan Sun Casino. Moreover, DiMassa conspired with his wife, Lauren DiMassa, to submit fake invoices for a youth violence prevention program. Lauren collected $147,776.10 for services she never delivered. She pleaded guilty on July 14, 2022, and received a six-month prison sentence along with a restitution order for the full amount. In another scheme, DiMassa partnered with John Trasacco, using fraudulent invoices from two companies, L&H Company and JIL Sanitation Services. They received $431,982 for bogus services, including work on a vacant school building. A jury found Trasacco guilty in December 2022, and he was sentenced to 96 months in prison with a restitution order of $143,994. Investigation and Legal Outcomes The Federal Bureau of Investigation and the U.S. Department of Housing and Urban Development led the investigation. Attorneys from the office of Vanessa Roberts Avery, U.S. Attorney for the District of Connecticut, prosecuted the case. For more news on legal and government accountability, visit JacobiJournal.com. Source: U.S. Department of Justice Read the official release here.

OSHA Targets New Jersey Contractor with $328K Fine for Fall Hazards

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Alleged Repeat Fall Hazards Found at Three Worksites The Occupational Safety and Health Administration (OSHA) has issued significant penalties to RRC Home Improvement Inc., a New Jersey-based contractor, for repeated safety violations. Inspections at three worksites in North Jersey revealed workers were allegedly exposed to dangerous fall hazards due to inadequate safety measures. OSHA Inspections Uncover Safety Violations OSHA first inspected an RRC Home Improvement worksite in Dover in June 2024 after reports surfaced of employees working on a roof without fall protection. Following a warning about this safety issue, OSHA initiated further inspections in July 2024 at two additional RRC worksites in Lodi. At these sites, inspectors once again observed employees without proper fall protection. In addition to fall-related hazards, the inspections revealed other violations, including: These findings highlight serious lapses in workplace safety protocols. Severe Penalties Issued for Violations New Jersey Contractor: After completing the three inspections, OSHA cited RRC Home Improvement for four willful and seven serious violations. These citations resulted in proposed penalties totaling $328,545. The company has a 15-business-day window to respond by complying, requesting an informal conference with OSHA’s area director, or contesting the findings before OSHA’s independent review commission. Repeat Offender Added to Severe Violators Program This is not the first time RRC Home Improvement has faced scrutiny from OSHA. Since 2017, the agency has conducted five inspections and issued citations for failing to provide adequate fall protection. Due to the willful nature of these offenses, OSHA has now added the company to its severe violators program. About RRC Home Improvement Inc. RRC Home Improvement provides commercial roofing, specialty roofing, and residential roofing services across New Jersey, New York, and Pennsylvania. Despite its regional presence, the company’s safety practices have repeatedly come under fire, underscoring the importance of strict compliance with federal workplace safety standards. Learn More About Workplace Safety To stay updated on workplace safety regulations and news, visit Jacobijournal.com, a trusted source for comprehensive legal and industry insights. For the full OSHA report on this case, visit the official OSHA website.

Insurance Fraud Settlement in the Midwest: Major Development

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Insurance Fraud Settlement: A significant fraud settlement has been reached involving an insurer in the Midwest. The case, reported by Insurance Journal (Read the full article), highlights ongoing challenges in combating fraudulent activities within the industry. Case Highlights: This case reminds insurers to remain vigilant and implement robust fraud detection mechanisms. It also illustrates the importance of collaboration between regulatory bodies and the private sector. Key Takeaways for Tax Professionals Insurance Fraud Settlement: Whether it’s individual or business-related taxes, 2024 is bringing significant shifts. Baker Tilly’s reports outline changes in deductions, tax brackets, and compliance rules. Here’s a snapshot: Discover actionable insights tailored for your needs by visiting their tax update resources: Learn More. Modernizing Fraud Investigations Fraud investigations often involve emotionally vulnerable individuals. Recognizing this, the use of trauma-informed principles is gaining traction, helping to build trust and ensure fair practices. Experts suggest: By emphasizing care, accuracy improves while communities feel better served. Learn more about implementing these approaches by exploring the original article on Insurance Fraud.org: Click Here. Shift gears with confidence this year by staying informed on the latest trends across asset management, tax planning, and enforcement strategies. For more updates on similar cases, visit Jacobi Journal.

Life Insurance Wagering Contracts and Identity Fraud: A Deadly Combination

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Life insurance fraud has entered a perilous phase with the rise of wagering contracts intertwined with identity fraud. Insurance Fraud.org explored this issue in depth (Read the full article). It exposes vulnerabilities in life insurance policies, endangering both financial systems and individuals. What Are Wagering Contracts? Life Insurance Wagering Contracts and Identity Fraud: A Deadly Combination, These fraudulent contracts involve policies obtained by individuals with no genuine insurable interest in the policyholder. Criminals exploit these policies using stolen identities or false data, aiming to cash in on payouts after the insured’s death. This practice undermines ethical and legal standards in the insurance industry. How Can Insurers Respond? Here are actionable steps insurers can take: Why It Matters The combination of wagering contracts and identity fraud represents a sophisticated threat to the life insurance sector. Tackling these challenges demands innovative solutions and industry-wide vigilance. For more updates on legal actions and regulatory news, visit Jacobi Journal.

Synthetic Fraud in Insurance: Adapting Strategies to Combat Evolving Threats

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Synthetic fraud has become a significant issue in the insurance industry. Unlike traditional fraud, it involves fabricated identities or entities. Criminals create these fake personas by combining stolen personal data with fictional information. These profiles appear legitimate in credit checks and identity verification systems. With advancements in artificial intelligence (AI), fraudsters can now create convincing synthetic identities at scale. These “synthetic IDs” allow criminals to exploit financial systems undetected. In the insurance sector, they file fraudulent claims using these fake identities. This leads to major financial losses and damage to the insurer’s reputation. Common Types of Synthetic Fraud in Insurance Synthetic fraud generally falls into two categories: Identity-Based Fraud Criminals blend real personal data with fake information to create a synthetic identity. They use these profiles to purchase insurance policies and later submit fraudulent claims. For example, a fraudster might buy a life insurance policy under a synthetic identity. After paying premiums for a while, they file a claim using fake death certificates and documents. Entity-Based Fraud This type involves creating fictitious businesses. Fraudsters use fake tax IDs, business registrations, and other documents to secure insurance policies. They then file claims for non-existent incidents like workplace injuries or property damage to collect payouts. The Fallout: Financial, Reputational, and Regulatory Risks Synthetic fraud creates significant challenges for insurers: Financial Losses Paying out fraudulent claims and the costs of investigations can quickly add up. Reputational Damage Cases of fraud damage customer trust, which can lead to lost clients. Regulatory Penalties Failing to address synthetic fraud can result in fines or increased scrutiny from regulators. Combatting Synthetic Fraud: Proven Strategies Insurers must adopt proactive, technology-driven solutions to combat synthetic fraud. Biometric Authentication Using biometric markers like fingerprints or facial recognition can verify real identities during applications and claims. This helps deter fraud. Advanced Analytics and AI Machine learning and predictive analytics can detect data anomalies and patterns that suggest fraudulent behavior. Entity Resolution This technology connects isolated data to create a complete picture of relationships between people, businesses, and organizations. This enhances fraud detection. Real-Time Monitoring Automated systems can flag suspicious activities, such as multiple claims from the same IP address or sudden changes to account details. Insurers can respond immediately to these alerts. Staying Ahead of the Curve As synthetic fraudsters become more sophisticated, insurers must innovate. By leveraging advanced technologies and collaborating with other industries like banking, insurers can build stronger defenses. With the right strategies and tools, the insurance sector can protect itself against synthetic fraud and ensure a safer experience for legitimate customers. Rowing wave of synthetic fraud and ensure a safer experience for legitimate customers. For more updates on legal actions and regulatory news, visit Jacobi Journal. For more updates on legal actions and regulatory news, visit Jacobi Journal.

Fraud Examiners: United in the Fight for Truth

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Fraud examiners and investigative journalists share a core mission: uncovering the truth. Both professions rely on interviewing, data analysis, and research tools to gather evidence, often collaborating to expose fraud. At the heart of their work is a commitment to seeking the facts and presenting them objectively. Why the Guardian Award Matters This shared mission inspired the creation of the Guardian Award, which is given annually to a journalist who has made a significant contribution to the fight against fraud. Nominees are selected based on their efforts to expose fraud and white-collar crime or raise awareness about fraud prevention and detection. The award celebrates qualities like determination, perseverance, and an unwavering commitment to truth—values that fraud examiners also hold dear. The 2016 Guardian Award Winner: David Barboza The recipient of the 2016 Guardian Award was David Barboza, a business correspondent for The New York Times. Barboza earned recognition for his groundbreaking investigative work exposing corruption within the Chinese government. His reporting revealed billions of dollars in hidden wealth controlled by the family of then-Prime Minister Wen Jiabao, earning him the 2013 Pulitzer Prize for International Reporting. Barboza’s Investigation In a detailed cover article, Barboza recounts how his investigation began by focusing on “state capitalism” and the business dealings of China’s political elite, often called “princelings.” He gained access to corporate records and shareholder information, leading him to uncover startling evidence. His investigation linked Wen Jiabao’s family to Ping An, one of China’s largest insurance companies. Initially, he discovered hundreds of millions of dollars tied to the family. However, further investigation revealed a total of $2.7 billion, which Barboza suggests may only represent a fraction of their true wealth. A Keynote Address at the ACFE Global Fraud Conference David Barboza will deliver a keynote address and receive the Guardian Award at the 27th Annual ACFE Global Fraud Conference. This event will take place from June 12-17 in Las Vegas. According to a report from https://www.fraud-magazine.com/ For more updates on legal actions and regulatory news, visit Jacobi Journal.