Former claims adjuster sentenced to 5 years in prison after defrauding two insurance companies

ORANGE COUNTY DISTRICT ATTORNEY PRESS RELEASE

Case # 14CF4001

Date: October 5, 2015

FORMER INSURANCE CLAIMS ADJUSTER SENTENCED TO FIVE YEARS IN PRISON FOR DEFRAUDING OVER $400,000 FROM TWO INSURANCE COMPANIES

SANTA ANA, Calif. – A former insurance claims adjuster was sentenced today to five years in state prison for defrauding over $418,000 from two insurance companies. Santos Aristires Rodriguez, 40, Monterey Park, pleaded guilty to a court offer today to 111 felony counts of insurance fraud written claim, two felony counts of grand theft, and sentencing enhancements for a pattern of related fraudulent felony conduct involving the taking of more than $100,000 but less than $500,000 and a taking exceeding $200,000. He is also expected to pay over $418,000 restitution in an upcoming court hearing.

From December 2010 to October 2011, Rodriguez worked as an insurance claims adjuster for Avizent, which is now owned by York Risk Group, Inc., and he also worked for Risk Enterprise Management, now known as Tristar Risk Enterprise Management from Oct. 20, 2011, to July 31, 2012. While employed there, he had access to the company’s database of insurance claimants.

Between 2011 and 2012, Rodriguez created three fraudulent medical companies Comp Medical Services, Linguistic Interpreting, and Imaging and Diagnostic Center. He used the companies as a way to create fraudulent lien demand letters, forged court documents, and other supporting documentation belonging to a legitimate claimant, which he obtained from the two companies he was working at, and then authorized the payments to be sent to his three companies. The defendant’s companies provided no medical services. Rodriguez defrauded over $400,000 from Avizent and Tristar Risk Enterprise Management.

Prior conviction in Los Angeles County

Prior to the Orange County case, between June 27, 2005, and June 30, 2009, Rodriguez worked as a claims adjuster for Chubb & Son Insurance Company where he embezzled more than $500,000 in a similar fraud scheme. On May, 14, 2015, Rodriguez pleaded guilty to one felony count of grand theft, one felony count of failure to file income tax return, one felony count of filing a false tax return, two felony counts of attempting to dissuade a witness, and a sentencing enhancement for money laundering and aggravated white collar crime involving a taking of more than $500,000 and sentenced to 10 years in state prison for that case. The defendant will serve the Orange County prison sentence consecutive to the Los Angeles County prison sentence.

The Orange County District Attorney’s Bureau of Investigation and the Los Angeles County District Attorney’s Office investigated this case.

Deputy District Attorney Debbie Jackson of the Insurance Fraud Unit prosecuted this case.

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TONY RACKAUCKAS, District Attorney

Susan Kang Schroeder, Chief of Staff
Office: 714-347-8408
Cell: 714-292-2718