The Pennsylvania Insurance Fraud Prevention Authority (IFPA) and the Pennsylvania Chapters of the International Association of Special Investigation Units (IASIU) have recognized the efforts of 18 individuals with annual Fraud Fighter Awards for their roles in the investigation and prosecution of insurance fraud cases across Pennsylvania.
Individual achievement and teamwork awards were presented by IFPA executive director Tom Donahue at the IFPA’s annual statewide conference, held April 23-24 at Hershey Lodge in Hershey, Pennsylvania. Now in its 10th year, the two-day event drew nearly 500 professionals to take part in workshops, training and certification opportunities with national and state experts.
Dr. Dan Bowerman was recognized for his decades of dedication to fighting healthcare insurance fraud as an expert analyst, lecturer and educator. During his 13-year career as chiropractic medical director for Independence Blue Cross (IBC), Dr. Bowerman worked closely with special investigators as he independently researched and data mined unusual practice and utilization patterns, leading to investigations and recoveries. After leaving IBC, he continued to contribute to anti-fraud efforts across Pennsylvania and nationally with expert support for SIU and local and federal law enforcement. He has lectured nationally and at the IFPA’s annual conference.
“Dan’s dedication goes beyond his working hours – spending countless, behind-the-scene time, communicating with, educating, and encouraging like-minded healthcare providers to develop their skills and contribute to the anti-fraud effort,” said Donahue. “He has contributed to decades of incarceration for individuals convicted of healthcare fraud as well as the recovery of significant funds in the battle against waste and abuse.”
Jim Seibert was honored for his career dedication to arson investigation and training, and leadership in the industry. During a 25-year law enforcement career with the Pennsylvania State Police as the regional Fire Marshal at Bloomsburg Barracks, Jim received numerous commendations and awards and became an active member of the Pennsylvania Association of Arson Investigators (PAAI) and the International Association of Arson Investigators (IAAI). After retiring from the PSP in 1992, Seibert went to Donegal Insurance Group, where he established the SIU Unit and conducted questionable claim-related investigations. In 1994, he was instrumental in establishing the Delaware Valley Chapter of the International Association of Special Investigation Units, of which he is still an active member. For more than a decade, Jim served on the board of directors for the Pennsylvania Association of Arson Investigators and handled coordination between law enforcement, municipal and state police fire marshals, and the SIU members in the insurance industry.
“In addition to his many on-the-job accomplishments, Jim has helped lead the development of arson investigation as a specialty profession, and helped other arson investigators develop professionally,” said Donahue, noting Seibert’s service as proctor of the Certified Insurance Fraud Investigator (CIFI) exam at the IFPA’s annual conference.
A Fraud Fighter Award was presented to the team of 16 professionals at the Pennsylvania Office of Attorney General who prosecuted Commonwealth vs. Claire Risoldi – a massive insurance fraud scheme involving millions in false and inflated insurance claims from multiple fires at a Bucks County mansion. This team included Senior Deputy Attorneys General Linda Montag, David Augenbraun, Kelly Sekula, Cari Mahler and John Flannery; Assistant Chief Deputy Attorney General Adrian Shchuka; Deputy Attorney General Matthew Connolly; Chief Deputy Attorney General Ronald Eisenberg; Supervisory Special Agents Luis Gomez and Richard Weisbrod; Special Agent Joseph Daniels; FBI Special Agent Stephen R. Gray; Senior Forensic Accountant Monique Ericson; Executive Secretary Cassandra Gillies, and Investigative Analysts Victoria Trumpp and Stephanie Wable.
After four years of investigation, prosecution and jury trial, Bucks County socialite Claire Risoldi, 71, was convicted of filing nearly $13 million in false insurance claims following a 2013 fire at her family’s 10-acre estate in New Hope, PA. She faces up to 60 years in prison after being found guilty of theft by deception, insurance fraud and other charges.
Investigators found that Risoldi cheated insurer AIG out of $2.75 million it paid for false claims related to drapes and alternative living expenses, and she attempted to bilk the insurer out of another $10 million by falsely claiming that firefighters had stolen her jewelry while they were in her home putting out the fire. The evidence presented to the Grand Jury established that Claire Risoldi conspired with her son Carl Risoldi and others to file the fraudulent and inflated claims, and that the Risoldis had diverted proceeds from the insurance claims to purchase luxury items, including numerous exotic high-end cars.
Investigators also found that on three prior occasions in 1984, 1993 and 2002, Claire Risoldi had filed claims and was paid for the same jewelry she reported stolen in 2013. The evidence showed that Carl Risoldi participated in the 2002 jewelry theft claim. Carl Risoldi testified as a defense witness during Claire Risoldi’s trial. Claire Risoldi is scheduled to be sentenced on May 17, 2019. The estate is being liquidated to help pay restitution.
“The Risoldis had been funding their extravagant lifestyle for decades by engaging in an ongoing course of insurance fraud,” said Donahue. “The Office of Attorney General’s team did a thorough job of uncovering layers of malfeasance, putting an end to these activities and ensuring that the money they stole will be returned.”