Gabriella Marshall, CFE

A Houston native, Gabriella Marshall, CFE, investigates insurance fraud and works with attorneys to mitigate fraudulent losses. She’s conducted investigations internationally and inspires family and community members to value justice as both a parent and special education advocate.

I was born and raised in Houston, Texas. I’ve lived there most of my life and spent significant time in the Alps in Northern Italy near the Austrian border. Growing up I loved to read books from the library and hike in the mountains with my sisters.

I’m a major case consultant for the Specialized Investigation Unit at Nationwide Insurance. I manage and conduct fraud investigations involving medical provider and attorney relationship fraud and staged accident rings for Texas and the surrounding states. I also consult with attorneys on fraud prevention and how to mitigate fraudulent losses.

Most of the fraud I see comes from faked medical records and supporting documents for insurance claims that are falsified. I gather the information I need to prove or disprove the fraud in an insurance claim by interviewing subjects and witnesses and doing fieldwork, including activity checks, clinic inspections and occasional spot surveillance.

I conduct due diligence investigations from open-source intelligence sources, review medical licensing, look for patterns in medical records and template billing, and prepare a case for either criminal prosecution through state and federal agencies or civil remedies. I believe you can’t effectively investigate fraud from behind a desk; the field component is essential, as well.

I once worked with federal law enforcement on a case in which a clinic owner hired a Houston surgeon to write fraudulent surgical recommendations and sign medical records saying he’d given epidural steroid injections to patients when he hadn’t. This was part of a larger federal workers’ compensation investigation that dovetailed with my own, and eventually the surgeon was indicted. He passed away in the hospital while the charges were being read to him.

I also worked on a complex investigation with my former employer to identify and locate a computer technician who stole thousands of dollars in electronic parts by having them sent to the houses of the people whose computers he was fixing. We caught him because he became impatient and called the house of one of the customers with a cell phone he’d purchased with his own name. We were able to trace his actions all over the southeastern U.S., and he was prosecuted in Florida.

I’ve always had a passion for fighting fraud. Soon after I graduated from college, I worked for the Texas Department of Health and Human Services as a caseworker for Medicaid and food assistance. I interviewed more than 10 families a day in my office and learned quickly how to interview people using open-ended questions and recognize the “tells” for when people were truthful and less than truthful. I also learned to interview in Spanish.

I’ve learned that writing is one of the most important skills for anyone who works in the anti-fraud field. While much is said about artificial intelligence, data analytics and the technology of the future, you must be able to write the results of an investigation in a succinct form that’s easy for a prosecutor or jury to understand. I’ve also learned how to spot anomalies in data, recognize unusual patterns that indicate a further look is necessary and choose the right investigative targets.

I obtained my Certified Fraud Examiner (CFE) credential in 2012 while working for American International Group, Inc. I felt stymied in my career and sought out the CFE Exam Prep Course, studying for a year while caring for 13-year-old quadruplets and my 11-year-old son. After I became a CFE, I was able to get a new job at Hewlett-Packard Company, where my salary almost doubled, and I could use my foreign service background and language abilities. I traveled internationally, working on audits in Brazil and conducting fraud investigations in Mexico, Peru and Costa Rica. I also worked on an international team with Global Security in Europe and Asia.

Because of the CFE credential, I’ve gotten more respect for my expertise and experience. Since then, I’ve had more opportunities to do more sophisticated fraud investigations, working with law enforcement at all levels and attorneys for civil litigation. Most importantly, being active in my local Association of Certified Fraud Examiners (ACFE) Chapter in Houston as a member, then as a board member and now as president, has benefited me professionally, given me new friends who understand my work and provided professional opportunities I wouldn’t have had otherwise.

My career advice for those starting out in the fraud-fighting field is to take the low-level jobs. Don’t say “no” to entry-level positions. I’ve found that doing your job to the best of your ability, even if it’s sweeping the floors at a fast-food restaurant, leads to promotion and opportunities. Intelligence and hard work speak for themselves. Always be kind to your coworkers and bosses and be willing to help someone else at work, especially if they’re struggling.

I consider my greatest achievement to be raising my five children and volunteering as a special education advocate. One of my daughters passed away from leukemia last year, which has greatly affected our family and our community. I’m immensely proud of my children, who are strong advocates in many areas of social justice, and I believe all these experiences, both professional and personal, have made me the person I am today.

Anna Brahce is the editorial assistant of Fraud Magazine. Contact her at ABrahce@ACFE.com.