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Zalma’s Insurance Fraud Letter – May 1, 2024

ZIFL Volume 28, Issue 9

Read the full article at https://lnkd.in/gKrPXeKp, see the full video at https://lnkd.in/gtnxcYp7 and at https://lnkd.in/ghkPnJiU, at https://zalma.com/blog, and at https://lnkd.in/gjU4vSe8.

Happy Law Day Post 4791

The Source for the Insurance Fraud Professional

Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at https://lnkd.in/gVT5G9s This issue contains the following articles:

Post 4791

See the full video at and at

The Source for the Insurance Fraud Professional

Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ This issue contains the following articles:

What is Insurance Fraud?

Next to tax fraud, insurance fraud is the most practiced crime in the world. It is perpetrated by members of every race, religion, and nationality. It is found in every profession. The possibility of a tax-free profit when coupled with the commonly held belief that criminal prosecution will probably not occur, is sometimes too difficult for normally honest people to resist.

Adapted from my book Insurance Fraud Volume I Second Edition

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

Man Bites Dog & Dog Bites Back

Third Circuit Compels Arbitration of IFPA Qui Tam Claims

The Insurance Fraud Prevention Act (IFPA) allows insurers to sue health care providers pursuing insurers with assignments of benefits from personal injury protection (PIP) claims (no fault insurance) on behalf of the state. GEICO did so against multiple health care providers who asked the court to compel GEICO to arbitrate each potential fraud claim.

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

More McClenny Moseley & Associates Issues

This is ZIFL’s twenty seventh installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

April 3, 2024 – Monson v. MMA, et al files a First Amended Complaint for Class Action and Damages in the USCA for the Southern District of Texas, Houston Division, Civil Action No. 4:23-cv-00928.

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

Now Available New Book

The Compact Book of Adjusting Property Claims – Fourth Edition

On January 2, 2024, in Kindle, paperback and hardback formats, The Compact Book of Adjusting Property Claims, Fourth Edition is now available for purchase here and here. The Fourth Edition contains updates and clarifications from the first three editions plus additional material for the working adjuster and the insurance coverage lawyer.

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

Criminal Tries to Get Out of Sentence

Fraudster Fails to Obtain Post Conviction Relief

Robert Sitler appealed from the order that dismissed his petition filed pursuant to the Post Conviction Relief Act (“PCRA”). A jury found him guilty of homicide by vehicle and the trial court, sitting without a jury.

In Commonwealth Of Pennsylvania v. Robert Sitler, No. 2946 EDA 2022, J-S20044-23, Superior Court of Pennsylvania (April 11, 2024) the appellate court refused to provide relief for Sitler.

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

From the Coalition Against Insurance Fraud

Tyburious M. Heyward, an insurance fraud ringleader who specializes in staged automobile accidents, has pleaded guilty in Sumter, South Carolina.

Heyward recruited dozens of individuals to participate as drivers and passengers in intentional automobile collisions to collect insurance payouts for nonexistent injuries from multiple insurance companies. Heyward directed his co-conspirators to seek unnecessary medical treatment for specific, subjective injuries and symptoms. Heyward also provided and directed the use of false medical, residency, identity, and lost wages documents throughout the claims processes. Heyward previously served time in prison for similar conduct. In fact, while incarcerated in the South Carolina Department of Corrections, Heyward used a contraband cell phone to recruit others to conduct staged accidents at his direction in this recent case. This case was prosecuted by Special Assistant Attorney General Joshua Underwood, the Director of SCDOI’s Insurance Fraud Division and investigated by agents of the South Carolina Law Enforcement Division (SLED) Insurance Fraud Unit.

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

Doctor Convicted for $5.4M Medicare Fraud Scheme

Adarsh Gupta, M.D., 51, of Sewell, New Jersey, a federal jury convicted a New Jersey doctor today for causing the submission of over $5.4 million in fraudulent claims to Medicare for orthotic braces ordered through a telemarketing scheme.

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

Insurer Immune from Malicious Prosecution Suit

SIU Report to State Made in Good Faith Makes it Immune from Suit for Malicious Prosecution

In The Hanover Insurance Group, Inc; and Michael Arline, Jr., v. Luke Frazier, No. 2D22-1689, Florida Court of Appeals, Second District (April 3, 2024) Luke Frazier sued The Hanover Insurance Group, Inc., and Michael Arline, Jr., an employee in Hanover’s Special Investigations Unit, for malicious prosecution.

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

New Book Now Available from Barry Zalma

Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition

Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition provides detailed guidance and practical information on the four primary areas of any investigation of suspicious claims. The book also examines recent developments in areas such as arson investigation procedures, bad faith, extracontractual damages, The fake burglary, and Lawyers Deceiving Insurers, Courts & Their Clients During, Catastrophes—A New Type Of Fraud and the appendices includes the NAIC Insurance Information and Privacy Protection Model Act and usable forms for everyone involved in claims and will provide necessary information to the claims adjuster, SIU fraud investigator, claims manager, or coverage lawyer so he or she can be capable of excellence.

The newest book joins other insurance, insurance claims, insurance fraud, and insurance law books by Barry Zalma all available at the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/

Other Insurance Fraud Convictions

Self Proclaimed ‘Godfather’ Gets 54 Years In Prison About a $150M Southern California Workers’ Comp Scheme

Peyman Heidary, 53, a man, who Riverside County Superior Court records say called himself “The Godfather,” was ordered to serve 54 years in state prison and pay $23 million in fines for masterminding a criminal organization that attempted to bilk the state out of $150 million in a workers’ compensation fraud the District Attorney’s Office said on Monday, April 15.

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8

Criminal’s Money Stays With State

Assets Forfeited to State are not Subject to Attachment

In B.D. v. Sussex County Prosecutor’s Office, No. A-1781-22, Superior Court of New Jersey, Appellate Division (April 19, 2024) the court dealt with the claims of a victim of a sex offender who attempted to get assets of offender that was forfeited to the state.

In this declaratory judgment action, plaintiff, B.D., appealed from the Law Division’s order dismissing his complaint, in which he sought to obtain proceeds forfeited to the Sussex County Prosecutor’s Office (SCPO) in a related health care insurance fraud case.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here. Houston Attorney Eric B. Dick Faces Sanction Again

Eric B. Dick, a well-known plaintiffs’ attorney in Houston, faces significant legal repercussions for the second time in recent months due to his litigation practices. Galveston County District Court Judge Kerry L. Neves recently ruled that Dick filed a groundless lawsuit against Standard Casualty Co. in bad faith, resulting in a summary judgment ordering Dick and the Dick Law Firm to reimburse the insurer over $100,000. This judgment follows a similar sanction of $137,000 in Harris County Civil Court against Dick for frivolous litigation against the same insurer.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here. Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected]

Over the last 55 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant.

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455

Read the complete article and the full issue of ZIFL in Adobe .pdf format https://lnkd.in/gjU4vSe8.

#fraud #insurance #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #investigationm SIU #investigator #claims #claims adjuster #claims investigation #insurance books #amazon.com

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bzalma · 1 month

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Zalma’s Insurance Fraud Letter – April 15, 2024

'Read the full article at https://lnkd.in/gfcuCcsR, See the full video at https://lnkd.in/gMd-3KQQ and at https://lnkd.in/gbgpZC5F and at https://zalma.com/blog plus more than 4750 posts.

ZIFL, Volume 28, Issue 8

The Source for the Insurance Fraud Professional

Zalma’s Insurance Fraud Letter – April 15, 2024 Posted on April 15, 2024 by Barry Zalma

ZIFL, Volume 28, Issue 8

Subscribe to ZIFL Here Post 4779

See the full video at https://rumble.com/v4p2ule-zalmas-insurance-fraud-letter-april-15-2024.html and at https://youtu.be/p6L-wEbN4_g The Source for the Insurance Fraud Professional

No Reason to Release Convicted Arsonist Early

In United States Of America v. Jonathan Paul Wiktorchik, Jr., No. 23-2564, United States Court of Appeals, Third Circuit (March 25, 2024) Federal Prisoner Jonathan Wiktorchik appealed, acting as his own lawyer, from the District Court’s denial of his motion for compassionate release.

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s twenty sixth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. March 11, 2024. Matthew Monson Reported That Mcclenny’s Sale To Moseley Uncovered! It was common knowledge that James McClenny sold his interest in MMA to Zach Moseley. New details revealed in a recent court filing. The deal was effective March 31, 2023.

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

Now Available New Book

The Compact Book of Adjusting Property Claims – Fourth Edition

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

Never Lie on an Application for Insurance

Conceal or Misrepresent Material Facts Requires Rescission in Alabama

Allied World sued general liability insurer concerning policies issued to Clint Lovette (“Lovette”) and his companies. ((collectively “Lovette Defendants”) for the policy periods of March 16, 2018, to March 16, 2019, and March 16, 2019, to March 16, 2020. Allied World sought a judicial determination in its favor that it does not owe the Lovette Defendants a defense or indemnity regarding two cases.

In Allied World Surplus Lines Insurance Company v. Lovette Properties, LLC, et al., No. 2:22-cv-00738-RDP, United States District Court, N.D. Alabama, Southern Division (March 15, 2024) the USDC resolved the disputes.

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

Pro Se Plaintiff’s Qui Tam Suit Fails

Private Citizen May Not Compel Enforcement of a Criminal Law

Ronald Rothman appealed from an order of the District Court dismissing his complaint with prejudice and remanding a foreclosure proceeding to state court.

In Ronald S. Rothman v. CABANA SERIES IV TRUST; IGLOO SERIES IV TRUST; U.S. BANK TRUST NATIONAL ASSOCIATION, as Trustee; WELLS FARGO BANK, N.A.; BALBEC CAPITAL, L.P.; SN SERVICING CORPORATION; FRIEDMAN VARTOLO, LLP; QUENTEN GILLIAM, ESQ., No. 23-2455, United States Court of Appeals, Third Circuit (April 2, 2024) the USCA, 3rd Circuit resolved the dispute.

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

Health Insurance Fraud Convictions

Holy Health Care Services, LLC Owner Sentenced to 3 Years In Federal Prison For Health Care Fraud Scheme

Julius Bakari, age 46, of Silver Spring, Maryland, was sentenced to 3 years in federal prison, followed by 3 years of supervised release, for conspiracy to commit health care fraud in connection with a scheme to fraudulently bill Medicaid. The defendant’s conviction stems from a scheme involving services purportedly provided by Holy Health Care Services, LLC (“Holy Health”), a mental health services provider with locations in Washington, D.C. Judge Xinis also ordered Bakari to pay restitution in the amount of the loss, $3,343,781. The sentence was imposed on April 9, 2024.

Read the full article with dozens more convictions and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf Arson for Profit

Arson for profit is the most egregious form of insurance fraud. Perpetrators of an arson for profit scheme do not consider the fact that arson can cause residents, neighbors, police, or firefighters to be injured or killed. Claims based on an arson-for-profit, are based upon the lack of intelligence or ability of the arsonist.

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

New Book Now Available from Barry Zalma

Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition provides detailed guidance and practical information on the four primary areas of any investigation of suspicious claims. The newest book joins other insurance, insurance claims, insurance fraud, and insurance law books by Barry Zalma all available at the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/

The Tiffany Kid

A Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.

How a Rich Kid Became an Insurance Fraudster.

The insured grew up with his wealthy parents on the shores of San Francisco Bay in Marin County. He wanted for nothing that money could buy. He was tall, blond, blue-eyed and handsome. Debutantes pulled their sister’s hair for the chance to dance with him. Life was good, but dull.

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

Other Insurance Fraud Convictions

Benicia Contractor Pleads Guilty To Insurance Fraud for Underreporting Nearly $1 Million In Payroll

Kent Bo Fridolfsson, 67, of Benicia, pleaded guilty to six charges of insurance fraud and grand theft after a joint investigation with the California Department of Insurance, Solano County District Attorney’s Office and the Employment Development Department (EDD) revealed he underreported payroll by nearly $1 million to illegally save on workers’ compensation insurance and taxes. Fridolfsson was placed on formal probation, ordered to pay over $725,000 in restitution, and ordered to surrender his contractor’s license.

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf Insurance Fraud Schemes

Every claims person and SIU investigator must be aware of the various schemes used by insurance criminals to defraud insurers. For example, the NAIC identified the following common schemes that result in the crime of insurance fraud…

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455; Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Go to the podcast Zalma On Insurance at https://podcastrs.spotify.com/pod/show/barry-zalma/support Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; I publish daily articles at https://zalma.substack.com, Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/04/ZIFL-04-15-2024.pdf

Benicia Contractor Pleads Guilty To Insurance Fraud for Underreporting Nearly $1 Million In Payroll

Insurance Fraud Schemes

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455.

#insurance #claims #insurance claims #fraud #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #investigation #invetigator #SIU #insurance books #amazon.com

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bzalma · 3 months

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Zalma’s Insurance Fraud Letter – March 15, 2024

ZIFL Volume 28, Issue 6

Barry Zalma

Mar 15, 2024

Read the full article at https://lnkd.in/g6Vkd5qF, at https://lnkd.in/g8AeJ97W, see the full video at https://lnkd.in/gZ27inZh and at https://lnkd.in/gC7Xi6tN and at https://zalma.com/blog plus more than 4750 posts.

Post 4755

The Source for the Insurance Fraud Professional

The current issue can be read in full at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-03-15-2024.pdf and includes the following articles: Arsonist Begs Ohio Court to Release Him From Prison

Compassionate Release Not Available to Convict Only Because he is Fat & Diabetic

ARSON-FOR-PROFIT IS A VIOLENT CRIME OF THE FIRST ORDER

Of the hundreds of different kinds of insurance fraud, the most violent and dangerous is an arson for profit. People, including firefighters, die or are seriously injured in the fires. Daryl Evans was caught, tried and convicted of the crimes and is now serving a 183-month sentence for insurance fraud relating to his arson of several Warren, Ohio properties.

Read the full article at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-03-15-2024.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s twenty fifth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

February 16, 2024

On February 16, 2024, MMA filed a Motion to Set Aside Default Judgment and For New Trial on the default judgment rendered against them on December 19, 2023, in the lawsuit filed by PCG Consulting. MMA was, at the time, represented by the reputable firm Phelps Dunbar LLP, who also represents the insurance industry on many matters.

Read the full article at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-03-15-2024.pdf

Now Available The Compact Book of Adjusting Property Claims – Fourth Edition

CHUTZPAH – CHARGE OF TWO SEPARATE CRIMES DO NOT VIOLATE CONSTITUTION

DIFFERENT CRIMES, DIFFERENT VICTIMS, DIFFERENT WITNESS, NO DOUBLE JEOPARDY

Gregory Sewell appealed the order that denied his motion to dismiss based upon double jeopardy. In Commonwealth Of Pennsylvania v. Gregory Sewell, No. 1497 MDA 2022, No. J-S27016-23, Superior Court of Pennsylvania (February 27, 2024) the Pennsylvania court resolved the dispute.

Read the full article at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-03-15-2024.pdf

From the Coalition Against Insurance Fraud

North Haven dentist sentenced in Medicaid fraud case. Christian O’Connor, a dentist and owner of Renew Dental in North Haven, was sentenced in Hartford Superior Court to five years in prison. O’Connor routinely billed for restorations on multiple teeth, on the same date of service, for numerous patients. A review of the dental records could not substantiate the work that was performed. Numerous patients interviewed denied the major dental work was done even though O’Connor billed for performing this work sometimes two and even three times on the same patient on the same teeth over a period of time, occasionally billing for work on teeth that already had been extracted. The investigation focused only on the claims for restorations on 12 teeth on the same day for the same patient. O’Connor paid over $200K in restitution and was ordered not to act as a provider in the Medicaid program.

Read the full article at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-03-15-2024.pdf

Health Insurance Fraud Convictions

Former Nurse Pleads Guilty to Adulteration of Fentanyl

Caroline Sheehan, 39, of Lowell, Mass. a former nurse pleaded guilty in federal court in Boston to adulteration of fentanyl at a local hospital. Sheehan pleaded guilty to one count of adulteration of a prescription drug with intent to defraud and mislead. U.S. District Court Judge Angel Kelley scheduled sentencing for June 12, 2024. Sheehan was charged by Information in November 2023.

Read the full article with dozens of convictions at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-03-15-2024.pdf

Insurance Fraud Costs Everyone

The Following is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.

Insurance Money tempts Honest Men to Commit Fraud

Fire reconstruction is a competitive trade. Work, rebuilding burned out businesses, commercial structures and homes requires specialized skill. Obtaining payment from insurers for this specialized work requires a gregarious personality, a talent at marketing, and the skill to do the work to perfection.

Read the full article with dozens of convictions at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-03-15-2024.pdf New Book Now Available from Barry Zalma

Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition

Other Insurance Fraud Convictions

How 9 Men Stole 45 Cars Over 6 Months During COVID, Then Got Caught

New York Attorney General Letitia James has announced the guilty pleas and sentencing of nine members of a Bronx car theft ring for their roles in the theft of 45 vehicles during a six-month period from April to October 2020.

Carried out during the beginning of the COVID-19 pandemic, the operation targeted cars in New York City and Westchester County that were parked on the street for days at a time.

Read the full article with many more convictions at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-03-15-2024.pdf

The Crime of Fraud

Most states and the federal government have created statutes making fraud like those described above a crime. For example, California Welfare and Institutions Code Section 12305.8 defines fraud as follows:

(a) ‘Fraud’ means the intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or herself or some other person. Fraud also includes any act that constitutes fraud under applicable federal or state law. [CA Welf. and Inst. Sec. 12305.8 Fraud defined; overpayment defined (California Code (2022 Edition)]

Adapted from my Book, “Insurance Fraud – Second Edition” Available as a Kindle book; Available as a Hardcover; Available as a Paperback

Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; I publish daily articles at https://zalma.substack.com, Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/

Adapted from my Book, “Insurance Fraud – Second Edition” Available at https://lnkd.in/gwf_Atvj

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Go to the Insurance Claims Library – https://lnkd.in/gKCTg53

#fraud #insurance fraud #claims #insurance claims #ZIFL #Zalma's Insurance Fraud Letter #investigation #insurance #insurance investigation #SIU #INSURANCE BOOKS #amazon.com

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bzalma · 4 months

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Zalma’s Insurance Fraud Letter February 1, 2024

ZIFL Volume 28 Issue 3

Barry Zalma Feb 1, 2024

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f; video at https://lnkd.in/gM-C-yif and at https://lnkd.in/gNPgmgqm, and go to https://zalma.com/blog plus more than 4700 posts.

See the full video at https://rumble.com/v4aircl-zalmas-insurance-fraud-letter... and at

The current issue can be read in full at http://zalma.com/.../uploads/2024/01/ZIFL-02-01-2024.pdf and includes the following articles:

Fraudulently Submitting Fake Applications Violates Licensing Statutes Insurance Producer Fraudulently Submits Applications to Insurer

Paul B. Kumar appealed a final agency decision of Commissioner of the Department of Banking and Insurance (Commissioner or Department) revoking his insurance producer license and imposing $60,774.25 in civil penalties, surcharge, attorney’s fees and costs of investigation, for violations of the New Jersey Insurance Producer Licensing Act of 2001 and the New Jersey Insurance Fraud Prevention Act (Fraud Act).

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

More McClenny Moseley & Associates Issues

This is ZIFL’s twenty third installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

12/19/2023

$10,170,665.53 Default Judgment Against MMA (Including Interest)

Read this full article and the entire issue of ZIFL here.Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Now Available The Compact Book of Adjusting Property Claims – Fourth Edition

On January 2, 2024, in Kindle, paperback and hardback formats, The Compact Book of Adjusting Property Claims, Fourth Edition is now available for purchase here.and here. The Fourth Edition contains updates and clarifications from the first three editions plus additional material for the working adjuster and the insurance coverage lawyer.

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Convictions From the Coalition Against Insurance Fraud

Dr. Michael Villarroel, working as a doctor in the US Navy, was sentenced in federal court to one year and one day in custody. Villarroel admitted that from 2012 to at least December 2015, he conspired with other members of the Navy to obtain money from the United States by making claims for life insurance payments based on exaggerated or fake injuries and disabilities. Villarroel certified that he reviewed the records and determined the injuries were legitimate when in fact he knew they were fake or exaggerated. At times, Villarroel falsely stated that he interviewed the claimant and provided other service members with actual medical records to be used in fabricating claims. Villarroel knew the claims were false, but he signed off on them to receive kickbacks once the fake injuries resulted in insurance payouts. In addition to prison time, Villarroel will have to pay $180K as criminal forfeiture.

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Health Insurance Fraud Convictions

Four Plead Guilty to Healthcare Offenses, Including Doctors and Lab Owners

Mark Rubin, 58, Renee Field, 44, Kelly Nelson, 52, and Carlos Hornedo, 61, were all charged via felony informations in December 2023. Mr. Rubin, on January 17th, and Mr. Hornedo, on January 10th, both pleaded guilty to one count of conspiracy to solicit and receive illegal kickbacks. On December 13th, Ms. Field and Ms. Nelson both pleaded guilty to one count of conspiracy to pay and receive health care kickbacks. The defendants each face a maximum penalty of not more than five years in federal prison, a $250,000 fine, and may be ordered to pay restitution.

Read this full article and the entire issue of ZIFL here.Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Lawyer With Unfortunate Name & Advertising Asking that People Should ‘Hire A Dick’ Faces Six Figure Sanctions

Eric B. Dick, Esq, for the second time in three months has been ordered to reimburse an insurer more than $100,000 for filing a “frivolous, groundless” lawsuit made “solely for the purpose of harassment.”

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

New Book Now Available from Barry Zalma Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Other Insurance Fraud Convictions

Life Insurance Fraud in South Africa

Onthatile Sebati and her co-accused and cousin Tumelo Mokone with Mokone’s brother Kagiso, were found guilty of killing her parents, sister and brother in 2016.

Sebati, 23, and her two cousins were found guilty in the Pretoria high court of murdering her father, mother, eight months pregnant sister and young brother. Sebati paid her cousins Tumelo and Kagiso Mokone R100,000 from life insurance payouts she received after the murders. She was 15 years old when she came up with the plot to kill her father, police constable Solomon Lucky Sebati, mother Mmatshepo, a nurse at an old-age home, her 19-year-old pregnant sister Tshegofatso and her young brother Quinton at their home at Mmakau near Brits in the North West in December 2016.

Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.

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Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.

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#fraud #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #insurance #claims #insurance claims #newsletter #SIU #investigation #insurance books #amazon.com

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bzalma · 6 months

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Zalma’s Insurance Fraud Letter – December 15, 2023The Resource for the Insurance Claims and Insurance Fraud Professionals

Barry Zalma

Dec 15, 2023

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Read the full article at https://lnkd.in/gBhj_4Vs and sthe full video at https://lnkd.in/g2DKPfye and at https://lnkd.in/gkbzw3xE and at https://zalma.com/blog plus more than 4690 posts.

ZIFL – Volume 27 – Issue 24

Merry Christmas, Happy Hanukah, and May the Winter Solstice be Peaceful & Mild

Post 4690

ZIFL-12-15-2023

See the full video at https://rumble.com/v419744-zalmas-insurance-fraud-letter... and at

This, the 24th issue of the 27th Year of ZIFL includes articles and reports relating to insurance fraud, including:

Former Root Marketing Exec Pleads Guilty to Taking Over $10 Million From the Insurer

Brinson Caleb “BC” Silver, former chief marketing officer for insurtech Root, has pleaded guilty to stealing more than $10 million from his former employer and violating court orders.

According to the U.S. Attorney’s Office for the Southern District of Ohio, Silver, 43, of Culver City, California, pleaded guilty to one count each of wire fraud and contempt of court and has agreed to pay more than $10.2 million in restitution. A prison sentence of 24-51 months has been recommended.

Read the full issue of ZIFL at http://zalma.com/.../uploads/2023/12/ZIFL-12-15-2023.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s twentieth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

December 8, 2023 – History of MMA Issues

Read the full issue of ZIFL at http://zalma.com/.../uploads/2023/12/ZIFL-12-15-2023.pdf

The Insurance Examination Under Oath

A Tool Available to Insurers to Thoroughly Investigate Claims

The insurance Examination Under Oath (“EUO”) is a formal type of interview authorized by an insurance contract. It is taken under the authority provided by a condition of the insurance contract that compels the insured to appear and give sworn testimony on the demand of the insurer or find his, her or its claim rejected for breach of a condition. A notary and a certified shorthand reporter are always present to give the oath to the person interviewed and record the entire conversation.

Read the full issue of ZIFL at http://zalma.com/.../uploads/2023/12/ZIFL-12-15-2023.pdf

Health Insurance Fraud Convictions

Doctor and Wife Admit Genetic Testing Kickback and Bribery Scheme

Yitzchok “Barry” Kurtzer, 63, and his wife, Robin Kurtzer, 62, both of Monsey, New York, a Pennsylvania doctor, and his wife admitted to their roles in schemes to solicit and receive kickbacks and bribes in exchange for ordering genetic tests.

Read the full issue of ZIFL and about dozens of fraud convictions at http://zalma.com/.../uploads/2023/12/ZIFL-12-15-2023.pdf

What is Needed to Deter Insurance Fraud?

To do so the insurers must train their staff to recognize the elements of both the crime of insurance fraud and the elements of the civil tort of insurance fraud. If well trained, insurance personnel collecting information about a potential insurance fraud, will know the type and quality of information that either a prosecutor or a civil defense lawyer will need to prove fraud was attempted.

Some estimates indicate that more money goes out fighting fraud than is saved. Others show that every dollar spent by insurers to defeat fraud save the insurer as much as seven dollars in fraudulent claims. Although insurance fraud is a crime in almost every jurisdiction in the United States it is seldom prosecuted.

Read the full issue of ZIFL at http://zalma.com/.../uploads/2023/12/ZIFL-12-15-2023.pdf

Other Insurance Fraud Convictions

North Carolina Insurance Agent Can’t Appeal Sentence in $700,000 Fraud

Glenda Taylor-Sanders, of Charlotte, North Carolina, a former insurance agent who pleaded guilty to defrauding trucking company clients and a premium finance company of hundreds of thousands of dollars cannot challenge her sentence and restitution order, a federal appeals court decided.

Read the full issue and dozens of convictions at http://zalma.com/.../uploads/2023/12/ZIFL-12-15-2023.pdf

Fraud After Catastrophes

Over the past few decades fraud has become an ever escalating problem. It is part of the CODB equation and quickly becomes just one more cost to be passed on to the insurance buying public. When a catastrophe hits everyone suffers. The victims of the catastrophe suffer. The insurers whose staff is not adequately trained to investigate and adjust claims and recognize fraud compounds the suffering of the victims and costs the insurer.

Read the full issue of ZIFL at http://zalma.com/.../uploads/2023/12/ZIFL-12-15-2023.pdf

Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at

http://www.zalma.com and [email protected]

http://www.zalma.com; http://zalma.com/blog; I publish daily articles at

Zalma on InsuranceInsurance, insurance claims, insurance law, and insurance fraud .By Barry Zalma

, Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.

Go to Zalma’s Insurance Fraud Letter at https://zalma.com/zalmas-insurance-fraud-letter-2/ Follow Mr. Zalma on Twitter at https://twitter.com/bzalma, Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921, Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ and GTTR at https://gettr.com/@zalma

Read the full issue of ZIFL at http://zalma.com/.../uploads/2023/12/ZIFL-12-15-2023.pdf

Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected]

#fraud #insurance fraud #claims #insurance #insurance claims #investigation #insurance fraud investigation #SIU #special investigative unit #ZIFL #Zalma's Insurance Fraud Letter #insurance books #amazon.com

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bzalma · 6 months

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Zalma’s Insurance Fraud Letter – December 1, 2023

The Resource for the Insurance Claims and Insurance Fraud Professionals

Barry Zalma Dec 1, 2023

Read the full article at https://lnkd.in/gGP8bVKD, see the full video at https://lnkd.in/gX4UTUKB and at https://lnkd.in/gyN26P57 and at https://zalma.com/blog plus more than 4650 posts.

ZIFL – Volume 27 Issue 23

This, the 22nd issue of the 27th Year of ZIFL includes articles and reports relating to insurance fraud, including:

Some Red Flags of Insurance Fraud

Over the last two centuries insurers, insurance investigators, Special Investigative Unit Investigators, insurance lawyers, and insurance management have developed lists of indicators of potential insurance fraud. The indicators are known as the Red Flags of Fraud and are used to determine if it is necessary to begin a thorough investigation of an insurance claim to determine if a fraud is being attempted.

To be able to work to deter or defeat attempts at insurance fraud the insurance claims person and the SIU investigators must be conversant in the red flags or indicators of insurance fraud.

Read the full 21 pages of this issue of ZIFL at http://zalma.com/.../uploads/2023/11/ZIFL-12-01-2023-1.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s nineteenth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

Read the full 21 pages of this issue of ZIFL at http://zalma.com/.../uploads/2023/11/ZIFL-12-01-2023-1.pdf

Litigation Financing

Although this report from Texas lawyer Steven Badger deals with the litigation around the MMA debacles it is more important for fraud investigators to understand what is happening in litigation financing.

Mr. Badger notes that “litigation financing and other interlopers [are] moving into the first-party claims world trying to line their pockets with insurance claim proceeds.” He concludes, and I agree: “This is a very dangerous trend.”

Litigation from an entity called Equal Access Justice Fund, LP loaned to MMA $30,000,000 at 20% per year interest plus an additional 4% in advance, extension, and yearly service fees would require the law firm to pay the lenders more than $600,000.00 a year. Unlike the U.S. government law firms cannot print money. For a normal law firm working on hourly billing that interest rate plus service fees is a scary, if not impossible, obligation to meet. Most law firms will not produce enough net income to pay $600,000 a year interest and be able to even consider paying off the principal.

In In Re: MMA a pleading filed in the Western District of Louisiana, by Intervenor Equal Access Justice Fund LP (“EAJF”) sought to recover the interest and principal from MMA and its partners as a result of its multiple hurricane suits that have bee removed from MMA’s control by the courts.

Chutzpah! Guess Who’s Back, Back Again?

MMA’s website is back up and running. The team is a bit smaller though. https://www.mma-pllc.com/our-team/ The new website for the MMA law firm states: “We believe that striking a balance between professionalism and self-empowerment is key to fostering a harmonious company culture—one where we are encouraged to build authentic relationships and welcome new opportunities.”

Read the full 21 pages of this issue of ZIFL at http://zalma.com/.../uploads/2023/11/ZIFL-12-01-2023-1.pdf

‘I Am Guilty.’ Murdaugh Pleads to 22 State Financial Crimes for 27 Year Sentence

Alex Murdaugh pleaded guilty November 17, 2023, to stealing millions of dollars from vulnerable legal clients in schemes lasting over a decade under an agreement that all but ensures more prison time for the longtime lawyer who was convicted of killing his wife and younger son.

Murdaugh agreed to plead guilty to 22 total counts, including money laundering, breach of trust and financial fraud, in exchange for a 27-year sentence. Judge Clifton Newman said he intends to officially accept the plea deal during a sentencing hearing set for Nov. 28 so that victims or their families may attend.

“I agree that I wrongly took all of that money, your honor, and did all of those crimes,” Murdaugh told Newman. “I am guilty,” he added.

Read the full 21 pages of this issue of ZIFL at http://zalma.com/.../uploads/2023/11/ZIFL-12-01-2023-1.pdf

Health Insurance Fraud Convictions

Psychiatrist Convicted of Billing for Services Never Rendered

Gustavo Kinrys, 52, of Wellesley, was convicted of seven counts of wire fraud, six counts of false statements relating to health care matters and one count of obstructing a criminal health care investigation. U.S. District Court Judge Denise J. Casper scheduled sentencing for Jan. 31, 2023. Kinrys was arrested and charged in December 2020.

Read the full 21 pages of this issue and dozens more convictions at ZIFL at http://zalma.com/.../uploads/2023/11/ZIFL-12-01-2023-1.pdf

Man Bites Dog Story

Lawyer Sanction Upheld for Intimidating and Harassing an Insurer

In Nguyen v. Aventus Ins. Co., 14-19-00607-CV (Tex. App. Sep 30, 2021) an April 2, 2018, sanctions order, that found that the lawsuit filed by Eric B. Dick, And Dick Law Firm, PLLC…” where the court found that the suit had no basis in fact, that it was brought in bad faith for the improper purpose of intimidating and harassing Aventus Insurance Company and that appellants hindered the litigation process and failed to make reasonable inquiries to ensure that the claims and pleadings were not groundless.

Read the full 21 pages of this issue of ZIFL at http://zalma.com/.../uploads/2023/11/ZIFL-12-01-2023-1.pdf

Other Insurance Fraud Convictions

Former Bail Agent And Torrance Police Officer Sentenced To 27 Years In Prison

Rehan Nazir, 51, of Torrance, was sentenced November 29, 2023, to 27 years after an investigation by the Los Angeles County Sheriff Major Crimes Bureau and the California Department of Insurance found he had apprehended bail clients prior to their required court appearances and threatened to return them to jail if they did not pay him money or give him property.

Read the full 21 pages of this issue of ZIFL and many more convictions at http://zalma.com/.../uploads/2023/11/ZIFL-12-01-2023-1.pdf

It is Expensive to Lie to Your Insurer

Fraud in Inception Allows Insurer to Rescind

Lamin Fatty appealed the trial court’s order granting summary disposition to Farm Bureau on the basis of finding Fatty’s fraud was grounds for contract rescission and reimbursement of benefits paid. In Lamin Fatty v. Farm Bureau Insurance Company of Michigan, No. 363888, Court of Appeals of Michigan (November 21, 2023).

Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business.

He is available at http://www.zalma.com and [email protected] and read the full 21 pages of this issue of ZIFL at http://zalma.com/.../uploads/2023/11/ZIFL-12-01-2023-1.pdf

#fraud #insurance #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #insurance books #amazon.com #SIU #Special Investigative Unit #red flags #red flags of fraud

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bzalma · 7 months

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Zalma’s Insurance Fraud Letter – November 1, 2023

ZIFL Volume 27, Issue 21

Barry Zalma Nov 1, 2023

Read the full article at https://lnkd.in/gxkV6rMt and see the full video at https://lnkd.in/gcze7hvA and at https://lnkd.in/g9yDwegV and at https://zalma.com/blog and https://lnkd.in/gzC4jCvG.

The Resource for the Insurance Claims and Insurance Fraud Professionals

What a Great Country!

"This article a fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is posted to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime."

How Insurance Fraud Can Succeed

Wo Ping Chen was trained as a physician in Hong Kong. Until Hong Kong was returned by the United Kingdom to the Peoples Republic of China, he was the best-known Orthopedist in the Crown Colony. Fearing problems with the new government he emigrated to Vancouver, British Columbia, Canada as a citizen of the commonwealth.

He worked as an employee of the National Health Service for a year and then obtained a work visa to the U.S. and crossed the border into the U.S. only to find he could not work as a physician without a license from a U.S. state and attended a U.S. based medical school. After one year of medical school, one year of internship in a Seattle hospital and one year as a resident Chen was able to restart his life.

Read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/gzC4jCvG.

More McClenny Moseley & Associates Issues

This is ZIFL’s seventeenth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

Access Restoration Services U.S., Inc. and MMA Scheme Alleged in Detailed New Orleans Court Pleading and more.

Read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/gzC4jCvG.

After Avoiding Prison Fraudster Appeals Unsuccessfully

False Lightning Strike Claim Results in Fraud Conviction

Sara Weisbeck appealed her convictions for insurance fraud: false material information and identity theft over $1500 and under $10,000, both class “D” felonies. In State of Iowa v. Sara Jo Weisbeck, No. 22-1068, Court of Appeals of Iowa (October 11, 2023) considered her pleas for mercy.

Read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/gzC4jCvG.

Health Insurance Fraud Convictions

Tampa Pain Management Physician Edward Lubin Agrees to Pay $1.5 Million To Settle False Claims Act Liability for Receiving Bribes and Writing Unnecessary Fentanyl Prescriptions

Edward Lubin, a pain management physician agreed to pay the United States $1.5 million to resolve allegations that he violated the False Claims Act (FCA) by causing the submission of claims for fentanyl prescriptions that were written in exchange for kickback payments and that were medically unnecessary. The agreement resolves the United States’ claims against Dr. Lubin under the FCA. The claims resolved by the settlement are allegations only, and there has been no admission or determination of liability.

Read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/gzC4jCvGand at http://zalma.com/.../uploads/2023/10/ZIFL-11-01-2023.pdf

Other Insurance Fraud Convictions

Claims Adjuster Will Serve Prison Time for Fraud Scheme

Paul Richard Massey, of Shady Spring, West Virginia, a former Allstate claims adjuster, will spend one year and a day in prison, forfeit his beach house and pickup truck to the federal government after pleading guilty to wire fraud and money laundering.

Federal prosecutors alleged that 51-year-old Massey issued 68 fraudulent checks from Allstate accounts totaling $862,871.29 while he worked as a claims adjuster in 2018 and 2019. Massey had settlement authority for up to $100,000 in his position with Allstate.

Read this article, and dozens convictions and the full 20 pages of this issue at ZIFL in pdf and read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/gzC4jCvG.

Crime Does Not Allow Insurer to Pay

Withholding Coverage for Criminal Acts Disincentivizes Criminal Conduct

Safeway Insurance Company sought supervisory writs from the judgment of the lower court which denied its motion for summary judgment. In Damien Harris v. Safeway Insurance Company Of Louisiana And Justin Rossette, No. CW 23-165, Court of Appeals of Louisiana, Third Circuit (October 25, 2023) the Louisiana Court of Appeals resolved an insurance coverage dispute over a criminal acts exclusion.

Read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/gzC4jCvG.

Please tell your friends and colleagues about this Newsletter, blog and the videos and let them subscribe to the blog and the videos.

Subscribe to Excellence in Claims Handling at locals.com at https://zalmaoninsurance.locals.com/subscribe or at substack at https://barryzalma.substack.com/publish/post/107007808

Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01

Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – http://zalma.com/blog/insurance-claims-library

Please tell your friends and colleagues about this Newsletter, blog and the videos and let them subscribe to the blog and the videos.

Go to Newsbreak.com https://lnkd.in/g8azKc34 Subscribe to substack at https://lnkd.in/gcZKhG6g

Read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/guPdbDe2 to the Insurance Claims Library – https://lnkd.in/gwEYkxD

#INSURANCE #fraud #insurance fraud #claims #insurance claims #ZIFL #Zalma's Insurance Fraud Letter #insurance books #amazon.cpom

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bzalma · 8 months

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Zalma’s Insurance Fraud Letter – October 15, 2023 Read the full article at https://lnkd.in/gwKMg8yC and see the full video at https://lnkd.in/gJdfQu_B and at https://lnkd.in/gAzA9tb2 and at https://zalma.com/blog plus more than 4600 posts. ZIFL Volume 27, Issue 20 This, the twentieth issue of the 27th year of publication Zalma’s Insurance Fraud Letter. Man Bites Dog: GEICO Bites Fraudsters - Don’t Ty to Defraud GEICO It Bites Back GEICO sued Defendants ALP Supply, Inc. (“ALP”), PV Supply, Inc. (“PV”), and Pal Vakula, alleging common law fraud and unjust enrichment claims. Read the full issue of Read the full article at https://lnkd.in/gwKMg8yC McClenny Moseley & Associates Issues This is ZIFL’s sixteenth installment of the saga of McClenny, Moseley & Associates. Read the full issue of ZIFL at Read the full article at https://lnkd.in/gwKMg8yC Evidence Required to Prove Fraud Insurer Not Required to Disclose How it Selects Limits and Premium Read the full issue of ZIFL Read the full article at https://lnkd.in/gwKMg8yC Good News From The Coalition Against Insurance Fraud Nerik Ilyayev and Mukhiddin Kadirov have pleaded guilty for multiple cases of insurance fraud. The pair face at least 10 years in prison each, with sentences pending. Read the full issue of ZIFL atRead the full article at https://lnkd.in/gwKMg8yC Not Wise to Explain Scheme to Defraud to FBI Informants Insurance Fraudster Tries Multiple Bases for Appeal & Still Goes to Jail For his conduct, a jury convicted Higgins on three counts of mail fraud under 18 U.S.C. §§ 1341-42 and two counts of retaliating against a witness, victim, or an informant under 18 U.S.C. § 1513(e). In United States of America v. Brian Higgins, No. 22-3538, United States Court of Appeals, Sixth Circuit (October 6, 2023) affirmed his conviction. Read the full issue of ZIFL at Read the full article at https://lnkd.in/gwKMg8yC California Conference of Arson Investigators Training Seminar As One of the Speakers, I encourage you to SIGN UP TODAY FOR THE OCTOBER 16 – 19, 2023 CCAI Fire Investigation Training Seminar – where you can learn How Insurers and Arson Investigators Have Taken the Profit from Arson-for-Profit from Attorney Barry Zalma, Esq. Register today by calling 909 865-5004 Or click here to register online. Read the full issue of ZIFL at Read the full article at https://lnkd.in/gwKMg8yC Health Insurance Fraud Convictions Husband And Wife Sent to Prison For $8M Health Care Fraud Read the about dozens of convictions at this part of the full issue of ZIFL at Read the full article at https://lnkd.in/gwKMg8yC Other Insurance Fraud Convictions Newtown Man Ordered to Pay Restitution for Fraudulent Practices John Paul Reis, 56, of Newtown Township, Pennsylvania entered an open guilty plea. Read the about dozens of convictions at this part of the full issue of ZIFL at Read the full article at https://lnkd.in/gwKMg8yC Read the full issue of ZIFL at https://lnkd.in/gkn3fpFX

#insurance #fraud #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #investigation #claims #insurance claims #insurance books #amazon.com

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bzalma · 9 months

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Zalma’s Insurance Fraud Letter – September 15, 2023

ZIFL Volume 27, Number 18

Barry Zalma Sep 15, 2023

Read the full article at https://lnkd.in/gXNAPqk4 and see the full video at https://lnkd.in/gP7zZsTE and at https://lnkd.in/gVB7WyUu and at https://zalma.com/blog plus more than 4600 posts.

Subscribe to Zalma’s Insurance Fraud Letter Where You Can be Notified About the two Issues a Month https://lnkd.in/gfpn78FM

The Source for Insurance Fraud Professional Where You Can Read:

Public Adjuster Andrew Mitchell Pled Guilty to Fraud

Andrew Mitchell aka Andrew Aga on August 31, 2023, pleaded guilty to defrauding four St. Chrles Parish, Louisiana residents of insurance money following Hurricane Ida. He has remained in custody since his arrest in January 2023.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s Fourteenth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

Crime Doesn’t – Pay it Costs

“Runner” Must Pay Restitution to Insurers

The Eighth Circuit was called upon to decide the amount of restitution owed by a participant in a recruitment-and-kickback scheme aimed at defrauding automobile-insurance companies. The district court ordered restitution for every chiropractic patient that Abdisalan Hussein recruited from 2013 onward.

In United States of America Plaintiff v. Abdisalan Abdulahab Hussein, also known as Abdisalan A. Hussein, No. 22-1275, United States Court of Appeals, Eighth Circuit (August 23, 2023) the Eighth Circuit resolved the dispute.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

A Different Kind of Insurance Fraud

Parag Bhavsar, 42, of Newark, pleaded guilty before US District Judge Madeline Cox Arleo to information charging him with one count of conspiracy to commit mail fraud and one count of conspiracy to commit interstate transfer of stolen property.

Bhavsar, an Indian national admitted that he defrauded various telephone providers and insurance companies out of millions of dollars by using stolen or fake identities to submit fraudulent claims for replacement cellular devices and then reselling those devices outside the US.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

Good News From the Coalition Against Insurance Fraud

Las Vegas man sentenced to 27 months for wire fraud and telemedicine scheme. Sergey Duman was sentenced for participating in a scheme to defraud private health insurance companies. Duman purchased Cedar Care Pharmacy in Allentown, Pennsylvania, in January 2020.

For the next six months, Cedar Care effectively acted as a shell pharmacy for a telemedicine fraud scheme. During that time, an entity purporting to be a telemedicine company regularly submitted prescriptions to the pharmacy that had been written without the knowledge of the listed patient. The pharmacy then fraudulently submitted private insurance, and Medicaid claims for the prescriptions even though the pharmacy never provided the prescribed medications to patients. He faces 27 months’ imprisonment for wire fraud. The Court also ordered a 3-year term of supervised release to follow the term of imprisonment and over $4.8M in restitution. The Texas Commissioner of Insurance Cassie Brown has served an emergency cease and desist order on multiple insurance companies.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

Strems Files for Bankruptcy –Will He Get His $36 Million?

Scot Strems, a Florida lawyer known as “public enemy number one” by Florida’s property insurance industry after it filed thousands of unnecessary lawsuits – many of them on the same claim – has slipped into bankruptcy, putting a deep red line under an expensive and frustrating chapter in the state’s insurance litigation crisis.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

Evidence of Arson Not Needed to Defeat Arson-for-Profit

Back in 2001 I examined James E. Mitchell under oath on behalf of his insurer, United National Insurance Company who admitted to misrepresenting material facts when he applied for the insurance. As a result of that EUO and the testimony of the underwriter, United National decided to rescind the policy rather than accuse him of fraud and arson for profit, but still refuse his claim for fire damage and offered to return the premium he paid. Of course, in an expression of “chutzpah” (unlimited gall) he sued only to have the court conclude the rescission was appropriate.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

Health Insurance Fraud Convictions

Dentist back in jail for practicing without a license

William C. Gardner used to advertise himself as the best cosmetic dentist in Albuquerque. Now he’s an inmate at the Sandoval County Detention Center, accused of “defiantly practicing dentistry” despite the revocation of his license more than three years ago.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

Rescission Results in Policy Void From its Inception

ARSON FOR PROFIT IS A VIOLENT CRIME

Imperial Casualty and Lloyd’s Underwriters retained me in the 1980’s to advise concerning the fire claim presented by Levon Sogomonian and his wife as a result of a major arson fire and explosion that destroyed their home. The investigation took more than a year, multiple days of examination under oath (EUO), death threats to the claims investigator and a bomb threat at my office, that eventually established the leading case in California concerning rescission of insurance.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

Other Insurance Fraud Convictions

Injured Worker Gets Help from a Friend…and a Bat

According to ICW Group a Florida Truck Driver who was injured on the job made a few unfortunate decisions when she decided she wasn’t ready to go back to work and wanted to make a little extra money. She asked a friend to hit her with a baseball bat! Her friend complied, but not to the satisfaction of the truck driver. The injured worker grabbed the bat and took a few extra swings at herself for good measure.

Read the full article and all of ZIFL at http://zalma.com/.../uploads/2023/09/ZIFL-09-15-2023.pdf

Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected]

#fraud #insurance #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #SIU #investigation #insurance books #amazon.com

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bzalma · 1 year

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Zalma's Insurance Fraud Letter - June 1, 2023ZIFL – Volume 27, Issue 11

Barry Zalma

Jun 1, 2023

Posted on June 1, 2023 by Barry Zalma

See the full video at https://rumble.com/v2r61ae-zalmas-insurance-fraud-letter-june-1-2023.html and at

The Source For Insurance Fraud Professionals

This, the eleventh issue of the 27th year of publication Zalma’s Insurance Fraud Letter provides multiple articles on how to deal with insurance fraud in the United States. The issue begins with:

Steal From the Government – Go to Jail - New Statute Requires Sentencing Review

In The People v. Howard Oliver, B317368, California Court of Appeals, Second District, Third Division (May 12, 2023) Howard Oliver appealed from the judgment entered after a jury convicted him of conspiracy to cheat and defraud Medi-Cal, Medi-Cal fraud; grand theft, false and fraudulent claims, insurance fraud, and four counts of tax evasion for 2012 through 2015. Oliver was sentenced to an aggregate sentence of seven years eight months in prison and ordered to pay over $2.85 million in restitution.

Read the full article & full issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-06-01-2023.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s seventh installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

Read the full article & full issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-06-01-2023.pdf

Dealing with Questionable Documents

Bogus receipts and the need for confirmation of purchase are closely connected, guidelines applicable to both are suggested to avoid fraudulent claims. The following guidelines are in a certain order, and it is suggested that a “by the numbers” approach be followed so that the investigation can be most effective and successful. This order is suggested because the claims person will be establishing and preserving certain evidence that will be difficult for the insured to dispute as the handling and investigation evolves.

Read the full article & full issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-06-01-2023.pdf

Good News from the Coalition Against Insurance Fraud

After initially pleading not guilty last year, Connie Jo Clampitt has been found guilty of over $7M in medical insurance fraud. Clampitt has since pleaded guilty, and both she and her partner, Terrance Barnard, were indicted for healthcare fraud.

Read about many more convictions and Read the full article & full issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-06-01-2023.pdf

Health Insurance Fraud Convictions

Boston Man Sentenced to Two Years in Prison for Benefit Fraud

Fernando Mateo Valenzuela, 69 a Hyde Park, Massachusetts man was sentenced May 24, 2023 in federal court in Boston for using a stolen identity to fraudulently obtain government assistance benefits.

Valenzuela was sentenced by U.S. District Court Judge Leo T. Sorokin to two years and one day in prison and three years of supervised release. Valenzuela was also ordered to pay restitution of $29,051 to the Department of Unemployment Assistance and $7,230 to the Department of Transitional Assistance.

Read about dozens more convictions and Read the full article & full issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-06-01-2023.pdf

Other Insurance Fraud Convictions

Yucaipa Driver And Wife Sentenced After YouTube Videos Of Intentional Collisions

Christopher Phelps, 40, of Yucaipa, and his wife, Kimberly Phelps, 40, were sentenced after pleading no contest to felony counts of insurance fraud, child abuse and assault with a deadly weapon. This comes after a Department of Insurance investigation revealed the couple caused collisions in an attempt to collect undeserved insurance payouts.

Read about many more convictions and Read the full article & full issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-06-01-2023.pdf

It’s Time to Subscribe to Locals or Substack

For Subscribers Only I Have Published Special Insurance Videos

I published on Locals.com more than 25 videos and two webinars of the Excellence in Claims Handling program. I also published on Substack.com videos and webinars of the Excellence in Claims Handling Program available only to Subscribers. The subscribers have access to all the videos and a webinar on “The Examination Under Oath A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud” among others.

The videos start with the history of insurance and work their way through various types of insurance and how to obtain and deal with insurance claims; Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com; Subscribe to my publications at substack at substack.com/refer/barryzalma; Go to substack at substack.com/refer/barryzalma; Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support

Read the full article & full issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-06-01-2023.pdf

Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; https://creators.newsbreak.com/home/content/post; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library

Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe.

Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808

Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01

Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected]

Follow me on LinkedIn: www.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257

#insurance #claims #insurance claims #fraud #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #insurance books #amazon.com

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bzalma · 1 year

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Zalma’s Insurance Fraud Letter – May 15, 2023

Zalma’s Insurance Fraud Letter – May 15, 2023 Barry Zalma May 16, 2023

Read the full article at https://lnkd.in/gY-E_Vh3 and see the full video at https://lnkd.in/gUwp4Vz9 and at https://lnkd.in/gb4Dncfy and at https://zalma.com/blog plus more than 4500 posts.

Issue Number 10 of the 27th year of publication of Zalma’s Insurance Fraud Letter provides in Adobe pdf format including the following articles. You can read the full 20 page issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Millions for Defense: Not a Dime for Tribute

Staged Accident Eliminates Coverage

In a no-fault auto insurance matter brought in New York, State Farm Fire and Casualty Company, as the plaintiff insurer established prima facie entitlement to summary judgment by:

1 submitting the examination under oath transcript of defendant insured Lesie Merle, in which she testified that she primarily garaged the car involved in the accident in Far Rockaway, New York, rather than in Connecticut;

2 the affidavit of its underwriter Christina Ardito, who establishes that such misrepresentation to plaintiff of the car’s location was material.

You can read the full 20 page issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s sixth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

You can read the full 20 page issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Prison for 195 Years

Arson Investigators May Testify as Experts as to Cause and Origin of Fire

Following NFPA Guidelines Establishes Expertise Defendant, Todd N. Perkins, appealed twenty-eight criminal convictions stemming from a jury’s verdict finding that he intentionally caused a building explosion. He challenged the trial court’s denial of a hearing to determine the reliability of the bases for the arson investigators’ opinions. In The People of the State of Colorado v. Todd N. Perkins, No. 20CA0882, 2023 COA 38, Court of Appeals of Colorado, Division A (May 4, 2023) the Court of Appeals dealt with claims of incompetent fire cause experts.

You can read the full 20 page issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Good News From the Coalition Against Insurance Fraud

Dam Ngoc Luong ran her own temporary workers agency and found out that, though her workers were temporary, insurance fraud is not. The Dorchester woman is now pleading guilty to a host of fraud charges. Prosecutors allege: From 2015 through 2019, Luong owned and operated Four Seasons Temp, Inc. When collecting payments from her temporary employment agency business clients, Luong cashed most of the checks rather than depositing the funds into her business account.

You can read the full 20 page issue including multiple reports of insurance fraud convictions at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Hard Fraud

Those who try to put fraud in more than one category move from soft fraud to what they call “hard fraud.” Hard fraud is considered a fraud or attempted fraud that is premeditated and intentionally committed.

It is considered “hard fraud” because the person perpetrating the fraud did so intentionally and the claim was made for the sole purpose of defrauding the insurer rather than a fraud of opportunity. Of course, fraud is always an intended act or failure to act that damages another. The differentiation exists because some fraud perpetrators are honest people tempted to “cheat a little” when a real claim appears while hard fraud perpetrators intend to do the crime even before a loss is reported. Both have committed the crime or cheated an insurer but soft fraud perpetrators are nicer than those who perpetrate hard fraud.

You can read the full 20 page issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Health Insurance Fraud Convictions

California Man Convicted of Health Care Kickback Conspiracy

Steven Donofrio, 49, was convicted by a jury on May 5, 2023, following a two-week trial before U.S. District Judge Robert W. Schroeder, III. Donofrio, a Temecula, California, man has been found guilty of federal violations related to a health care kickback scheme in the Eastern District of Texas.

You can read the full 20 page issue including multiple reports of insurance fraud convictions at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Other Insurance Fraud Convictions Crop Insurance Fraud Conviction

James Garrett, age 68, was sentenced to 18 months in federal prison, followed by two years of supervised release, and ordered to pay $1,045,544 in restitution to the United http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

States. Levi Garrett, age 44, was sentenced to 24 months in federal prison, followed by two years of supervised release, and ordered to pay $279,396 in restitution to the United States. Chief Judge Roberto A. Lange, U.S. District Court, has sentenced the two Sully County, South Dakota, men convicted of False Statements in Connection with Federal Crop Insurance. The sentencing took place on January 30, 2023.

You can read the full 20 page issue including multiple reports of insurance fraud convictions at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Arson for Profit

Arson is probably the dumbest form of insurance fraud. With modern municipal fire departments arson fires seldom totally destroy the premises, evidence is always left for arson investigators to review, and firefighters and the public are exposed to danger of injury and death and, as a result, judges have little mercy for an arsonist. Arsonists hoping to make a profit from a fire seldom sit back and accept their punishment when they are convicted.

You can read the full 20 page issue including multiple reports of insurance fraud convictions at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected]

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455; Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe

Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; I publish daily articles at https://zalma.substack.com, Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.

You can read the full 20 page issue at http://zalma.com/blog/wp-content/uploads/2023/05/ZIFL-05-15-2023.pdf

Barry Zalma

Barry Zalma, Esq., CFE is available at http://www.zalma.com and [email protected]

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455;

Subscribe to Zalma on Insurance at locals.com

https://lnkd.in/gn5WAi6C.

Subscribe to Excellence in Claims Handling at https://lnkd.in/gNm9EWKJ.

You can read the full 20 page issue at https://lnkd.in/gJwkcP5q

#fraud #insurance fraud #insurance #claims #INSURANCE CLAIMS #ZIFL #Zalma's Insurance Fraud Letter #insurance books #amazon.com

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bzalma · 1 year

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Zalma’s Insurance Fraud Letter – April 15, 2023

ZIFL – Volume 27, Issue 8

Barry Zalma

Apr 14, 2023

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

Read the full article at https://lnkd.in/gsRNYMwf and see the full video at https://lnkd.in/gDas9K4s and at https://lnkd.in/ghVbnk-9 and at https://zalma.com/blog plus more than 4450 posts.

Obesity, Diabetes and Covid Not Basis For Compassionate Release

The US Congress, feeling sorry for federal prisoners, amended the law to create The First Step Act to allow a District Court to shorten a sentence when there exist extraordinary and compelling reasons to release the Prisoner. In United States Of America v. Earl Lee Planck, Jr., Criminal No. 5:20-CR-24-KKC-MAS-1, United States District Court, E.D. Kentucky, Central Division, Lexington (March 1, 2023) Earl Lee Planck, Jr moved the USDC for compassionate release under the statute.

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

The Special Investigative Unit Investigator

Insurance companies now retain the services—either by employing them directly or by use of independent contractors—of investigators whose expertise relates exclusively to insurance claims and suspected insurance fraud. The experienced claims investigator is usually a part of, or vendor to, a Special Investigative Unit (SIU) set up to protect the insurer and mandated by most states as a means to reduce the amount of fraud perpetrated against insurers.

The fact that an insured is contacted by a claim investigator does not, however, mean that the insured is suspected of committing fraud. By virtue of his or her training and experience, the claim investigator is more skilled than the claim adjuster in discerning facts and evidence that can be used in a court of law if a fraud has been attempted.

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

More McClenny Moseley & Associates Issues

This is ZIFL’s fourth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

Chutzpah Defined

“Chutzpah” is a Yiddish term that has found its way into the English language. It is defined as “unmitigated gall” and is usually explained as a person convicted of murdering his parents who pleaded with the judge for mercy because he is an orphan. The latest actions by McClenny Moseley & Associates are a better definition of the term.

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

Free Insurance Videos

Barry Zalma, Esq., CFE has published five days a week videos on insurance claims, insurance claims law, insurance fraud and insurance coverage matters at https://www.rumble.com/zalma.https://rumble.com/c/c-262921.

He now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and he practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 55 years in the insurance business. He is available at http://www.zalma.com and [email protected].

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

The Problem with Different Degrees of Crime

Fraud by any Other Name is Still Fraud

Pursuant to the New Jersey Code of Criminal Justice (Code), one can be charged with the offense of insurance fraud for knowingly making a false or misleading statement of material fact in connection with an insurance claim. That third-degree offense may be elevated to the second degree by aggregating five “acts” of insurance fraud, the total value of which exceeds $1,000.

In State Of New Jersey v. Randi Fleischman, A-4 September Term 2006, Supreme Court of New Jersey (March 26, 2007) the Supreme Court of New Jersey was provided with its first opportunity to construe N.J.S.A. 2C:21-4.6’s penalizing of a false “statement” as an “act of insurance fraud” that can be accumulated to elevate insurance fraud to a second-degree offense.

The State indicted defendant Randi Fleischman for second-degree insurance fraud. The factual underpinnings for the charge were based on various items of false information contained in defendant’s statements to the police and to her automobile insurer in connection with a stolen car claim.

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

Good News From the Coalition Against Insurance Fraud

A home healthcare company has paid $9M for allegedly submitting false claims. United Energy Workers Healthcare, Corp. and related entities settled a claim with several entities including Ohio, to the U.S. Department of Energy employees and its contractors. An investigation alleged: between January 2013 and March 2021, defendants submitted claims for payment for in-home healthcare services that were never provided or were medically unnecessary, in violation of the False Claims Act. Various of the violations included: billing for case management services not actually provided, instructing caregivers to charge for more time than actually spent with patients, providing and billing for services to beneficiaries that were not covered, and providing services without possessing required licenses. Plus many more convictions for fraud.

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

OBLIGATION OF LAWYERS WHEN A CLIENT IS SUSPECTED OF FRAUDULENT CONDUCT

A lawyer who suspects that his or her client is lying about the facts to cover up fraudulent or criminal activity the lawyer is placed in a professional dilemma. The client may be faking injuries after an automobile accident or fabricating the cause of a fire at his or her home. Or the client provides the lawyer with intentionally vague information about their finances to avoid reporting the information to the IRS or other governmental agency.

In July 2021, the Colorado Bar Association Ethics Committee adopted Formal Opinion 142, addressing a lawyer’s duty to inquire when the lawyer knows a client is seeking advice on a transactional matter that may be criminal or fraudulent. Like the Model Rules of Professional Conduct counterpart, Colorado’s rule 1.2(d) provides that a lawyer “shall not counsel a client to engage, or assist a client, in conduct that the lawyer knows is criminal or fraudulent . . .”

The opinion specifically discusses what happens when the lawyer suspects but does not actually know, that the client may be using the legal services to engage in criminal or fraudulent conduct. While the term “know” denotes “actual knowledge of the fact in question” under Colorado Rule 1.0(f), the Committee interpreted the actual knowledge standard to include “willful blindness.”

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

Health Insurance Fraud Convictions

Santa Rosa Doctor Sentenced To 2.5 Years in Prison for Unlawfully Prescribing Controlled Substances

Thomas Keller, formerly a pain management doctor in Santa Rosa, was sentenced to 30 months in prison for distributing Schedule II and IV controlled substances outside the scope of his professional practice and without a legitimate medical need. The sentence was handed down by the Hon. Vince Chhabria, United States District Judge, after a jury found Keller was guilty of the crimes at trial in November 2022. Read about this and dozens more convictions.

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

Other Insurance Fraud Convictions

Richfield Woman Sentenced To 10 Years Behind Bars for Insurance Fraud

The Department Of Insurance Became Aware That She Was Again Misappropriating Funds With The New Agency.

Charlotte Sheppard of Richfield, Idaho is headed to prison after committing insurance fraud. Sheppard allegedly stole her clients’ insurance premium to pay her personal and business bills and obligations.

She was sentenced to the Idaho Department of Corrections for 10 years, with five years fixed and five years indeterminate.

Sheppard was first prosecuted and found guilty in Blaine County for grand theft in 2020. But while awaiting criminal sentencing and administrative penalties, she took over the management of a second agency in Lincoln County. The Department of Insurance became aware that she was again misappropriating funds with the new agency. The DOI issued a cease-and-desist order on March 18, 2020, and revoked her license two days later. Also many more reports of convictions.

Read the full issue of ZIFL-04-15-2023Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

Barry Zalma

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455; Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; I publish daily articles at https://zalma.substack.com, Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.

Read the full issue of ZIFL-04-15-2023 Read the full issue of ZIFL https://lnkd.in/g7Q9iuVd

Subscribe to Zalma on Insurance at locals.com

Go to the Insurance Claims Library – https://lnkd.in/gKCTg53

Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://lnkd.in/gV9QJYH; Go to the Insurance Claims Library – https://lnkd.in/gFKp5WhW consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.

Read the full issue of Zalma's Insurance Fraud Letter at https://lnkd.in/g7Q9iuVd

#fraud #insurance fraud #insurancefraud #ZIFL #Zalma's Insurance fraud Letter #claims #insurance claims #insurance books #amazon.com

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bzalma · 1 year

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Zalma's Insurance Fraud Letter = April 1, 2023

ZIFL Volume 27, Issue 7

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Read the full article at https://lnkd.in/gMkdtjJp and see the full video at https://lnkd.in/g8CXb5y8 and at https://lnkd.in/gH_7mjXr and at https://zalma.com/blog.

The Source For Insurance Fraud Professionals

Louisiana and Texas Charge Public Adjuster

Not an April Fools Story

Andrew Joseph Mitchell, was indicted by a grand jury in Kimble County, Texas

Read the full article and the full issue at https://lnkd.in/gP6eNrMp The Victims of Fraud

Very often insurers are the victims of fraud.

Read the full article and the full issue at https://lnkd.in/gP6eNrMp More McClenny Moseley & Associates Issues

This is ZIFL’s third installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana.

Read the full article and the full issue at https://lnkd.in/gP6eNrMp

Free Insurance Videos

See the more than 600 videos at https://lnkd.in/g6i3cWu. Good News from the Coalition Against Insurance Fraud

Multiple reports of insurance fraud convictions

Read the full article and the full issue at https://lnkd.in/gP6eNrMp What is Insurance Fraud?

Insurance fraud is the most popular and perpetrated crime in the world next to, perhaps, tax fraud.

Read the full article and the full issue at https://lnkd.in/gP6eNrMp

Health Insurance Fraud Convictions

Hundreds Of Millions of Potential Liability Result from Federal Jury False Claims Act Verdict

Read the full article including dozens of convictions and the full issue at https://lnkd.in/gP6eNrMp

Other Insurance Fraud Convictions

Sady Ribeiro, 72, was sentenced to 36 months in prison for his participation in a scheme to obtain fraudulent insurance reimbursements.

Read the full article including dozens of convictions and the full issue at https://lnkd.in/gP6eNrMp

It’s Time to Subscribe to Locals or Substack https://lnkd.in/gjdauQht

#insurance #fraud #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #insurance claims #claims #insurance books #amazon.com

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bzalma · 1 year

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Zalma’s Insurance Fraud Letter – March 15, 2023Zalma’s Insurance Fraud Letter – March 15, 2023

Barry Zalma

Read the full article at https://lnkd.in/gsuWpSz3 and see the full video at https://lnkd.in/gx9AA5RS and at https://lnkd.in/gHc_HzuB and at https://zalma.com/blog plus more than 4450 posts.

Posted on March 15, 2023 by Barry Zalma

ZIFL – Volume 27, Issue 6

See the full video at https://rumble.com/v2d3mrk-zalmas-insurance-fraud-letter-march-15-2023.html and at

Ohio Insurance Department Warns of ‘Past Posting’ Fraud Scheme

The Ohio Department of Insurance warned of an insurance fraud scheme committed after an auto accident or property damage that is trending in the state. Named the “past posting” scheme, the term describes the action of a person attempting to secure insurance after an incident in which they did not have coverage or making it appear they had insurance when the incident occurred, such as by manipulating paperwork.

Read this article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-03-15-2023.pdf

The California Bar Admits It’s Failure to Properly Deal with now Disbarred Tom Girardi

State Bar Employees Bribed to Ignore Wrongful Conduct by Now Disbarred Attorney

Former State Bar employee Tom Layton, who was terminated in 2015, (and his wife) received gifts and payments estimated at over $1 million from Girardi, through his firm, while Layton was employed at the State Bar. Those payments and gifts were never properly disclosed.

Other State Bar employees and Board members accepted and failed to report gifts and other items of value from Girardi.

Relatives of staff members were employed by Girardi’s firm.

Staff in the Office of Chief Trial Counsel (OCTC) were improperly involved in matters assigned to outside conflict counsel.

Eight Girardi cases were closed by individuals who May determined had conflicts of interest at the time they worked on the cases. The report found that their conflicts tainted their decisions to close the cases.

Interim Executive Director Bob Hawley ghostwrote decisions in matters assigned to outside conflict counsel without disclosing that fact, including a decision to recommend closure of a complaint against Girardi.

Between 2013 and 2015, both the Executive Director’s Office and Office of General Counsel received reports about Girardi’s influence at the State Bar and connection to Layton and others but failed to investigate.

Former Executive Director Joe Dunn, who was terminated in 2014, and Hawley made questionable terminations of two OCTC attorneys who were advocating for disciplinary actions against Girardi.

On at least one occasion, Girardi successfully deployed his connections at the State Bar to discourage people from making complaints against him.

Read this article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-03-15-2023.pdf

More McClenny Moseley & Associates Issues

Three attorneys who once worked in MMA’s New Orleans office have posted notice on their LinkedIn pages that they are now “self-employed.” Founding partner James M. McClenny has resigned from the law firm. Several attorneys who once worked for the law firm outside of Louisiana are no longer listed on the law firm’s website. After the Louisiana Supreme Court suspended Huey last week, the bios of the three other attorneys who worked with him in the New Orleans office disappeared from MMA’s website.

Read this article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-03-15-2023.pdf

Good News from the Coalition Against Insurance Fraud

A soulless soul-food murder plot was shut down.

The owner of a soul-food restaurant featured on the hit TV reality show Welcome to Sweetie Pie’s had his nephew gunned down for a $450K life policy. James “Tim” Norman received life in prison for arranging a hit on his nephew Andre Montgomery in St. Louis. Norman paid Travell Anthony Hill $5K to shoot Montgomery with a .380-caliber handgun outside the rap studio where Montgomery worked. He then disposed of the gun and his burner phone. Exotic dancer Terica Ellis was in a relationship with Norman. He paid her $10K in cash to lure Montgomery to where he was shot. Insurance agent Waiel “Wally” Rebhi Yaghnam helped Norman secretly take out life insurance that named Norman the sole beneficiary if Montgomery died. Yaghnam helped Norman file applications that included false info about Montgomery’s net worth and background. Norman called the insurance agency to collect the insurance money just 16 days after Montgomery was shot. He also fake-played the role of grieving relative. TV clips from Welcome to Sweetie Pie’s circulated showing Norman mourning the death he himself set up. Norman even visited the murder scene with his mother and TV cameras in an episode. “Since Andre’s passing I haven’t gone through this part of the city,” Norman said on the show. “I’ve been avoiding it.” The entire murder crew now stands convicted.

Read this article including dozens of convictions and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-03-15-2023.pdf

Health Insurance Fraud Convictions

Former State Lawmaker Sentenced for COVID-19 Fraud Scheme at Springfield Health Care Charity

Patricia “Tricia” Ashton Derges, 64, of Nixa, Mo., was sentenced by U.S. District Judge Brian C. Wimes to six years and three months in federal prison without parole. The court also ordered Derges to pay $500,600 in restitution to her victims.

Read this article including dozens of convictions and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-03-15-2023.pdf

Other Insurance Fraud Convictions

LA Business Owner and Conspirator Sentenced In $54 Million Workers’ Compensation Fraud Scheme

Wesley Owens, 54, of Atlanta, Georgia, and Beau Wilson, 38, also of Atlanta, pleaded no contest to multiple felony counts of insurance fraud and conspiracy in Department 50 of the Los Angeles Superior Court before Judge Kerry White. The charges were filed after a California Department of Insurance investigation found the two defendants perpetrated a $54 million workers’ compensation insurance fraud scheme.

Read this article including dozens of convictions and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-03-15-2023.pdf

It’s Time to Subscribe to Locals or Substack

For Subscribers Only I Have Published Special Insurance Videos

I published on Locals.com more than 25 videos and two webinars of the Excellence in Claims Handling program. I also published on Substack.com videos and webinars of the Excellence in Claims Handling Program available only to Subscribers. The subscribes have access to all the videos and a webinar on “The Examination Under Oath A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud” among others.

Read this article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-03-15-2023.pdf

Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe.

Consider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected]

Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library.

Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://lnkd.in/gfFKUaTf.

Read this article including dozens of convictions and the full issue of ZIFL at https://lnkd.in/gQez4kRh

Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://lnkd.in/gV9QJYH; Go to Barry Zalma on YouTube- https://lnkd.in/g3cjXbnE to the Insurance Claims Library – https://lnkd.in/gWVSBde.

#fraud #insurance fraud #claims #insurance claims #ZIFL #Zalma's Insurance Fraud Letter #lawyers #fraudulent lawyers #fraud schemes #insurance books #amazon.com

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bzalma · 1 year

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Zalma's Insrance Fraud Letter - March 1, 2023

ZIFL Volume 27 Number 5 Barry Zalma

Read the full article at https://lnkd.in/gXiVeBE2 and see the full video at https://lnkd.in/gdTK4Qmu and at https://lnkd.in/gEhvKF4p, and read the full 22 page ZIFL in pdf format at https://lnkd.in/gzErgazV and at https://zalma.com/blog plus more than 4450 posts.

McClenny Moseley & Associates & Insurance Fraud

The McClenny Moseley & Associates (MMA) series of lawsuits, court hearings and insurance department actions have brought about some very serious problems for MMA, including court orders, lawsuit dismissals, administrative cease and desist orders and litigation, all of which have created a poster child for Zalma’s Insurance Fraud Letter.

Since MMA has admitted that it reported a claim to various insurers, including Allied Insurance, that it was presenting claims against Allied and at least 856 claims to Allied and other insurers, that it represented the insured when, in truth and fact, it did not represent the insurer’s insureds, but, rather Apex Roofing who is not an insured of any of the insurers to whom MMA made claims, demanded appraisal and settled claims, cashed checks and took attorneys fees from people it did not represent the insurer is obligated to report each claim to the Louisiana Department of Insurance as a suspected insurance fraud effected or attempted.

Therefore, it appears, subject to the review of the Louisiana Attorney General and/or local prosecutors, MMA violated Louisiana fraud statutes, and each insurer who is a victim of one or more of the minimum of 856 fraudulent claims where MMA represented it was the attorney of the insurers’ insureds was a criminal fraudulent act.

Since the actions of Velawcity and Apex Roofing appear to meet the definition of a “runner” the prosecutors in the state of Louisiana should consider prosecution for their fraudulent activities.

In addition, the federal judges involved in these cases should consider reporting MMA, Velawcity and Apex Roofing to the U.S. Attorney for investigation of the potential crime of wire fraud.

There will be more hearings in March 2023 that will be reported in the March 15, 2023 issue of ZIFL.

Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.

The Arson for Profit Defense

To prove the “arson for profit defense” the insurer must prove the three elements needed to establish arson plus proof that the insured violated the misrepresentation, concealment, or fraud condition, and/or that the act was an intentional act to defraud the insurer.

A successful “arson for profit defense” depends on a wide range of evidence, including expert testimony, knowledgeable and convincing witnesses, and effective counsel for the insurer. Where any of the evidence as to each element is non-existent, weak, or sufficiently rebutted by the insured’s experts and witnesses, the insurer’s “arson for profit defense” will likely fail.

Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.

Good News from the Coalition Against Insurance Fraud

A firm that administered health care claims stole $18M of funds intended for paying the claims. Anthony Riccardi started by administering third-party healthcare claims for a car dealership chain in New Canaan, Conn. Employee Benefit Solutions created invoices for the car dealership brand, which submitted payments and expected the funds to be paid to health care providers. EBS stole almost $18M of $26M the dealership paid. Most of this money was transferred into the EBS operating account and used for non-company expenses — mortgages, boats, golf and luxury cars. Riccardi only paid claims from health care providers he thought were likely to complain, or involved the car dealership execs. The scam also included inflated or bogus medical claims, including some by a phony company under Riccardi’s name. Unpaid financial obligations began to mount, prompting Riccardi to apply for millions in fraudulent bank loans and cash advances. They were used in part to pay financial obligations to the car dealership brand. To cover up the loan scheme, Riccardi forged invoices from a fake company that supposedly sold upgraded billing software to EBS. Ricardi pled federally guilty. He faces up to 30 years in prison when sentenced and agreed to repay $14.8M.

Read the full article plus many more reports of convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf. How to Add to the Professionalism of Insurance Claims Professionals

Every insurer, insurance syndicate, insurance brokerage, insurance sales agency, insurer branch office, and vendors to the insurance industry should add to the libraries of their various offices or employees.

Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.

Health Insurance Fraud Convictions

Ronald A. Beasley II, 33, of Portsmouth, Florida was the pharmacist in charge at NH Pharma, a pharmacy located in Lake Mary, Florida. Through NH Pharma, Beasley and his co-conspirators billed Medicare for expensive compound drug creams that they never

actually purchased or dispensed, and instead provided Medicare patients an inexpensive compound drug cream not covered by Medicare.

Inventory records showed that NH Pharma did not buy enough of the expensive prescription drugs to fill all the prescriptions NH Pharma billed to Medicare. In total, Beasley and his co-conspirators received more than $1 million in fraudulent proceeds from Medicare.

A federal jury in the Middle District of Florida convicted Beasley, a Virginia man February 9, 2023 for his role in a scheme to defraud Medicare of over $1 million in prescription drug benefits.

Beasley was convicted of conspiracy to commit health care fraud and three counts of health care fraud. He is scheduled to be sentenced on April 25 and faces a maximum penalty of 10 years in prison on each count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Read the full article including more than a dozen convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.

The Brothers Ben-Cohain

The story that follows is a fictionalized True Crime Story of Insurance Fraud from my 55 Years in Insurance that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. This is one of more than 80 stories in my book “Insurance Fraud Costs Everyone“ Available as a Kindle Book and Available as a Paperback from Amazon.com.

In 1990 Moshe Ben-Cohain and Menashe Ben-Cohain started a course of conduct that led to their arrest for insurance fraud. They failed to appear after posting bond and are, along with their co-conspirator, Raz Rosenberg, fugitives.

Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.

Other Insurance Fraud Convictions

Herbert Allen, age 38, and Dion Ridley, age 23, pleaded guilty to Conspiracy to Commit Mail Fraud in violation of Title 18, United States Code, Section 371 Allen was to 37 months in prison, followed by 3 years of supervised release and Ridley was sentenced to 6 months in prison, followed by 1 year of supervised release.

The defendants admitted to being in a conspiracy to commit mail fraud in connection with a staged automobile collision. In the scheme, Allen falsely claimed that he was the driver of a car that was struck by a tractor-trailer on June 28, 2017. Ridley, a passenger in the car, falsely claimed that Allen was driving the car and they were struck by a tractor-trailer.

In fact, the government’s evidence showed that the defendants conspired with Damien Labeaud, Roderick Hickman, and others to intentionally collide Allen’s 2007 Chevrolet Impala with a tractor-trailer in the area of Tchoupitoulas Street and Calliope Street in New Orleans.

Read the full article and about many more insurance fraud convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.

Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe.

Go to substack at substack.com/refer/barryzalma Consider subscribing to my publications at substack at substack.com/refer/barryzalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected]

Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com. Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library

Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://lnkd.in/gfFKUaTf.

Go to substack at https://lnkd.in/gEEnV7Dd Consider subscribing to my publications at substack at https://lnkd.in/gEEnV7Dd

Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected]

Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg;Go to the Insurance Claims Library – https://lnkd.in/gWVSBde

#fraud #insurance #claims #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #arson #arson for profit #McClenny #insurance books #amazon.com

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bzalma · 2 years

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Zalma’s Insurance Fraud Letter – August 1, 2022

Posted on July 30, 2022 by Barry Zalma

ZIFL – Volume 26, Issue 15

Read the full 22 page Adobe .pdf Newsletter at http://zalma.com/blog/wp-content/uploads/2022/07/ZIFL-08-01-2022.pdf

See the full video at https://youtu.be/2VV8A0uoZpY and at https://rumble.com/v1e5zqf-zalmas-insurance-fraud-letter-august-1-2022.html

Articles include:

“The Need to Understand the Mutability of Memory When Investigating a Fraud”

Very few people have a perfect eidetic (photographic) memory. Memory is a fluid and often unreliable human function.

During my time as a trainee investigator at the Army Intelligence School at Fort Holabird, Maryland, a classroom lecture on interviewing was interrupted by a man dressed in a clown mask, a tuxedo, swim fins, a cowboy hat, and a purple cummerbund. He ran into the room, screamed epithets, fired a weapon into the ceiling, and ran out. The teacher instructed each member of the class to write down a description of the intruder. None of our descriptions was accurate, and we were all shocked when the shooter was brought back into the class. The noise he made, the firing of a weapon, and the fear the incident engendered made it almost impossible to recall him accurately. Some even described him as having been female.

The professional recognizes that some EUO techniques can cause honest subjects — those who are innocent but “just trying to be helpful” — to “misremember” and provide unreliable, even false, information. It has long been known that false memories can be implanted by a process of suggestion, especially when used by skillful but unscrupulous attorneys or interviewers.

California Claims Regulations

Insurers licensed or operating in California must file their SIU annual reports by Wednesday, Sept. 28 and Insurers licensed or operating in California must ascertain that their entire claims staff has read, understood or be trained about the California Fair Claims Settlement Practices Regulations by September 1 of Each Year and be ready to swear under oath that the Regulation has been complied with by the insurer.

Insurance Agent Should not Sell Unregistered Securities

Unregistered Security Exclusion Eliminates Duty to Defend or Indemnify

William Saoud sells insurance-related products. Beginning in 2017, he offered some of his clients a new financial instrument: a Memorandum of Indebtedness issued by 1 Global Capital, LLC. The investment opportunity was too good to be true. William Saoud, Patricia Boland- Saoud, and Bill Saoud Financial, LLC v. Everest Indemnity Insurance Company, No. 21-1621, United States Court of Appeals, Sixth Circuit (July 14, 2022)

Free Insurance Videos

Intending Harm Caused is not Insurable

State Farm Fire and Casualty Company filed a motion for summary judgment, arguing that it owed no duty to defend or indemnify defendants, Hamdallah, L.L.C., et al. (“the LLCs”), against the claims asserted by plaintiff, Nixon Calix. The trial court granted for summary judgment and dismissed all claims against State Farm with prejudice.

In Nixon R. Calix v. Ideal Market # 6, Hamdallah, L.L.C., Kaki and Son, LLC, Hamdallah Hasan “Mario” Kaki, Muwafak “Mike” Kaki, Monadel “Cory” Elbarqa, Nofal “George” Haifa John Does 1-4, El Cortez Foods, LLC, And ABC & XYZ Insurance Company, No. 21-CA-555, Court of Appeals of Louisiana, Fifth Circuit (July 13, 2022) explained the right to rely on a clear and unambiguous exclusion.

Good News From The Coalition Against Insurance Fraud

For example: Dr. Jose Santeiro lured patients for medically unneeded rehab in a $112M fleecing of private insurers in South Florida. Recruiters paid kickbacks to con addicted patients into attending Santeiro’s detox facilities, then plied them with illegal drugs to ensure they were admitted. Santeiro made false claims for excessive urinalysis drug tests that weren’t even used in treatment. Santeiro then readmitted a core group of addicted patients he shuffled between Compass Detox and another facility to fraudulently bill for as much bogus drug treatment as possible. Santeiro also prescribed Compass Detox patients an addictive “comfort drink” to sedate them so they’d stay at the facility and keep returning. And he let cohorts use his log-in at the detox facilities to sign electronic medical files to make it falsely appear he provided treatment. Santeiro was given 4 1/2 years in federal prison.

Convicted of Wire & Insurance Fraud

After being convicted of multiple counts of fraud Ejaz Shreef was sentenced to a term of imprisonment for 48 months on each count, concurrent, followed by two years of supervised release.

In Ejaz Shreef v. United States of America, Nos. 3:18-cr-157-RJC-DCK-2, 3:22-cv-78-RJC, United States District Court, W.D. North Carolina, Charlotte Division (July 8, 2022) resolved his motion to reduce his sentence in favor of the government.

Health Insurance Fraud Convictions

Including a story why a Jury Convicts Man of $600 Million Health Care Fraud, Wire Fraud, and ID Theft Scheme. Mathew James, 54, of East Northport, was convicted by a federal jury. James, a New York man was convicted over $600 million health care fraud, wire fraud, and identity theft scheme.

Zalma on Insurance at Locals.com

Create a Staff of Professional Claims Handlers

Click Here to Subscribe to the Excellence in Claims Handling Programs for Each of Your Claims Personnel for Only $5 A Month Or $50 A Year by Subscribing to Zalma on Insurance at Locals.

Barry Zalma has created at Locals.com a series of insurance educational materials most of which are free to anyone. The free materials include more than 441 videos and more than 4200 digests of recent appellate court opinions and more than 81 videos dealing with true crime stories of insurance fraud.

Another Complaint Surfaces on Strems Over Settlement & Fee Deal

Scot Strems, the pain in the bank accounts of Florida insurers could see his two-year suspension completed in July 2022. But allegations by the state Bar could result in new sanctions or even a permanent disbarment.

A 25-page complaint, separate from previous allegations, charges that Miami attorney Strems and his law firm, in 2018 informed a client of a settlement with a property insurance company but then secretly settled with the insurer for twice as much and attempted to pocket a large, unauthorized fee.

In Addition, Another Strems Law Firm Attorney Suspended by Florida Supreme Court

Fallout from the infamous Strems Law Firm’s litigation practices in Florida continues. Two years after Coral Gables plaintiffs’ attorney Scot Strems was suspended from practice for filing thousands of unnecessary lawsuits against property insurers and violating other Bar rules, and two years after the Florida Bar filed a complaint against another attorney with the firm, the state Supreme Court has suspended the lawyer for 91 days.

Other Insurance Fraud Convictions

Insurance Fraud is a Violent Crime – Two Guilty in Sweetie Pie’s Murder-For-Hire Plot

For example: Terica Ellis and Waiel Rebhi Yaghnam charged with the murder-for-hire plot that led to the death of Andre Montgomery in 2016 pleaded guilty July 22, 2022.

In 2020, the two were charged with conspiracy to commit wire and mail fraud. Yaghnam was charged with five counts of aggravated identify theft. Montgomery, the grandson of original Sweetie Pie’s owner Robbie Montgomery, was shot and killed near Fairground Park on March 14, 2016. James Timothy Norman, Montgomery’s uncle, has been charged with conspiracy to use a cellphone in the “commission” of a murder-for-hire that resulted in death. Charging documents revealed that Norman took out a $450,000 life insurance policy on his nephew in 2014 and Norman was the sole beneficiary.

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and [email protected].

Over the last 54 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455;

Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; I publish daily articles at https://zalma.substack.com, Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921

#insurance #claims #insurance claims #fraud #insurance fraud #ZIFL #Zalma's Insurance Fraud Letter #August 1 #2022 #insurance books #amazon.com

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