In a case that reads less like a crime report and more like a rejected film script, four individuals stand accused of attempting to turn the safety net of travel insurance into a personal piggy bank, authorities announced Thursday.
The alleged plot, which involved fictitious trips, phantom hospitalizations, and brazen duplication of paperwork, sought to bilk insurers out of a quarter of a million dollars from the comfort of New Jersey and New York homes.
The state grand jury indictment names Agustin Matos, 40, of North Haledon; Kenia Ivonne Vasquez, 44, of the Bronx; and Keyra Carla Liriano, 45, and Patricio Arturo Alfonso, 46, both of Fort Lee.
They face a suite of charges, including conspiracy, insurance fraud, and theft by deception, for a scheme that operated from April 2022 to August 2023.
According to the Office of the Insurance Fraud Prosecutor (OIFP), the method was both simple and audacious.
The defendants allegedly took out multiple travel insurance policies for the same trip to the same foreign destination, using false identities and interconnected credit card information.
Then, from the familiar surroundings of Bergen, Hudson, and Passaic counties, they reportedly filed claims with each insurer, asserting they had been hospitalized abroad and incurred thousands of dollars in medical expenses.
They certified they had no other coverage for the trip or medical costs—a statement investigators say was as false as the claims themselves.
“The defendants in this case are charged with coming up with a simple—yet potentially lucrative—scam by taking out multiple travel insurance policies and then filing claims against them for trips they never actually took and for medical emergencies they allegedly fabricated,” said Attorney General Matthew J. Platkin.
An investigation triggered by a referral from American International Group Inc. (AIG) revealed a tapestry of fiction. The defendants had not traveled to the countries they named and had never been hospitalized as claimed. Almost all documents submitted—medical records, receipts, and proofs of travel—were allegedly “altered, fraudulent, or completely fabricated.”
While most insurers denied the claims, authorities say Liriano successfully obtained $14,835 from two carriers. In total, the attempted fraud amounted to approximately $252,852, with individual attempted thefts ranging from $19,986 to $167,829.
“Insurance exists for various reasons, and enriching yourself illegally is not one of them,” said Division of Criminal Justice Director Theresa L. Hilton. “The defendants we’re charging in this scheme tried to turn it into an illegal business.”
The case is a localized snapshot of a national malady. While this group allegedly aimed for a quarter-million dollars, fraud elsewhere operates on a staggering scale.
In Minnesota, federal prosecutors recently estimated that losses across state-run programs could reach into the billions, with one nutrition program alone at the center of a $250 million fraud case.
Nationally, the Government Accountability Office has estimated that annual fraud losses across the federal government could be as high as $521 billion.
In New Jersey, the legal system is actively grappling with how best to prosecute such fraud.
A recent state appellate decision emphasized that complex fraud allegations, like those under the Insurance Fraud Prevention Act, deserve the full discovery and judicial scrutiny of a courtroom rather than being funneled into streamlined arbitration processes.
This judicial stance underscores the serious consequences the defendants now face: second-degree crimes carry a sentence of five to 10 years in state prison and a fine of up to $150,000.
Interim Insurance Fraud Prosecutor Al Garcia highlighted the essential cooperation with the insurance industry that exposed the scheme.
The public also plays a role; the OIFP maintains a toll-free hotline (1-877-55-FRAUD) and a website for anonymous tips, with potential rewards for information leading to convictions.
The charges are merely accusations, and the defendants are presumed innocent unless proven guilty. Yet, if the allegations hold, they paint a picture not of master criminals but of grifters betting that a system built on trust would not look too closely at a forged document or a duplicated story.
It is a reminder that the cost of fraud is never absorbed by a corporate ledger alone; it is distributed in the form of higher premiums, a corrosion of trust, and a system forced to scrutinize the legitimate claims of honest people.
Deputy Attorney General Jana Robinson is prosecuting the case for the OIFP.