Zalma’s Insurance Fraud Letter – 10-15-2022
Barry Zalma, Esq., CFE
Insurance claims expert, consultant at Barry Zalma, Inc. and author/Publisher at ClaimSchool, Inc.
Zalma’s Insurance Fraud Letter -Volume 26, Issue 20 – October 15, 2022
Posted on October 14, 2022 by Barry Zalma
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Quote of the Issue
"He Who Tampers With The Currency Robs Labor Of Its Bread." Daniel Webster
Ethics & Insurance Fraud
Insurance fraud is a crime in most jurisdictions. In California it is a felony subject to five years in prison upon conviction. By definition a person who commits the crime of insurance fraud is not acting ethically.
In State v. Whitaker, 175 P.3d 136, 117 Hawai=i 26 (Haw. App. 12/31/2007) Whitaker, after presenting a claim to his insurer, was indicted, convicted, and sentenced for Insurance Fraud in violation of Hawaii Revised Statutes (HRS) ' 431:10C?307.7(a)(1) and (b)(2) (2005), and Attempted Theft in the Second Degree (Attempted Theft 2) in violation of HRS ' 708?831(1)(b) (Supp. 2000) and HRS ' 705?500 (1993).
On the evening of February 28, 2001, Whitaker parked his car on a grassy area about ten to twenty feet from his family=s home in Wahiawa.
The adjuster explained that the damages were inconsistent with a vehicle being vandalized. It was just too detailed, too extensive. When your car gets vandalized, the adjuster explained, it is random, they come and go in an instant. It is just that every part of his vehicle was damaged, either scratched or indented and so forth; it was just too detailed. The adjuster explained that he and his profession have red flags that they look at as far as each claim that insurers get. An ethical adjuster faced with the inconsistent type of damage from cars vandalized, must report his suspicions to the police.
The court noted that there are three material elements of the offense of Insurance Fraud, each of which the prosecution must prove beyond a reasonable doubt. These three elements, which were met at trial, are:
??That on or about March 1st, 2001, to and including March 6th, 2001, in the City and County of Honolulu, State of Hawaii, [Whitaker] knowingly presented, caused or permitted to be presented false information on a claim to AIG Hawaii Insurance Company, Inc.;
??That [Whitaker] did so with the intent to obtain benefits, or recovery, or compensation for benefits or services provided; to wit, insurance proceeds; and
??That [Whitaker] believed the value of the benefits, or recovery, or compensation for benefits or services provided; to wit, insurance proceeds, exceeded $300.
In multiple acts cases where several acts are alleged and any one of them could constitute the crime charged, the State must either elect the criminal act upon which it will rely for conviction, or the circuit court must instruct the jurors that all of them must agree that the same underlying criminal act has been proved beyond a reasonable doubt.
The Insurance Fraud charge was based on a single incident of culpable conduct – the submission of a false claim to AIG for insurance benefits – and not on two separate claims for benefits to repair, respectively, the alleged self?inflicted scratches and the alleged pre?existing damages. As a result, the fraud conviction was affirmed.
In Liberty Mutual Insurance Co. v. Land, 892 A.2d 1240, 186 N.J. 163 (N.J. 03/14/2006) the Supreme Court Of New Jersey was asked to determine the appropriate standard of proof under the Insurance Fraud Prevention Act (IFPA).
The IFPA and its legislative history are silent concerning the applicable standard of proof. The Court sought to understand the Legislature=s intent from its purpose in promulgating the Act and its context.
The New Jersey IFPA is a comprehensive statute designed to help remedy high insurance premiums, which the Legislature deemed to be a significant problem. A person or practitioner violates the Act by making a knowingly false statement in support of or in opposition to a claim for payment under an insurance policy. In enacting the IFPA, the Legislature did not codify common law fraud but supplemented it because, standing alone, common law fraud had proven insufficient in combating and deterring insurance fraud.
A review of analogous fraud statutes, rules of statutory construction, and related considerations persuaded the Court that the proper standard of proof is a preponderance of the evidence. The federal counterpart to the IFPA, the False Claims Act, similarly requires proof by a preponderance of the evidence. This standard also applies in proceedings to enforce anti-fraud provisions of the federal securities laws.
The court reversed the Appellate Division on the evidentiary issue in this appeal and hold that the standard of proof under the New Jersey Insurance Fraud Prevention Act is a preponderance of the evidence.
Adapted from my book The Compact Book on Ethics for the Insurance Professional available as a Kindle book , a Paperback or a Hardcover
Wisdom
“The truth is incontrovertible. Panic may resent it; ignorance may deride it; malice may distort it, but there it is.”—Winston Churchill
"Give up money, give up fame, give up science, give the earth itself and all it contains rather than do an immoral act." —Thomas Jefferson
“The tendency of taxation is to create a class of persons who do not labor, to take from those who do labor the produce of that labor, and to give it to those who do not labor." —William Cobbett
“A lie can travel halfway around the world while the truth is still putting on its shoes.” –Jonathan Swift
“We are all precious to the Creator. He who shows others kindness and respect, honors the Divine Himself.” — The Alter of Slabodka “I have reached an age when, if someone tells me to wear socks, I don’t have to.” — Albert Einstein
“This triangle of truisms, of father, mother and child, cannot be destroyed; it can only destroy those civilizations which disregard it.” — G. K. Chesterton
"To prevent crimes, is the noblest end and aim of criminal jurisprudence. To punish them, is one of the means necessary for the accomplishment of this noble end and aim." — James Wilson
“The secret of success is to do the common thing uncommonly well.”— John D. Rockefeller Jr.
“It is amazing what you can accomplish if you do not care who gets the credit.” — Harry S. Truman
“It does not require many words to speak the truth.” – Chief Joseph
"Where there is no law, there is no liberty; and nothing deserves the name of law but that which is certain and universal in its operation upon all the members of the community." —Benjamin Rush
"We may explain success mainly by one word and that word is WORK! WORK!! WORK!!! WORK!!!! Not transient and fitful effort, but patient, enduring, honest, unremitting, and indefatigable work, into which the whole heart is put." —Frederick Douglass
RICO Judgment Allows Disgorgement Damages
Fraudsters Must Disgorge Profits of Crime
In Diane Creel and Lynn Creel v. Dr. Says, LLC, et al., Civil Action No. 4:18-CV-00615, United States District Court, E.D. Texas, Sherman Division (September 27, 2022) the plaintiffs obtained a verdict against Defendants Dr. Yupo Jesse Chang; MD Reliance, Inc.; Universal Physicians, PA; Dr. Says, LLC; Office Winsome, LLC; and Yung Husan Yao (aka Angela Yao) for violations of the civil Racketeer Influenced and Corrupt Organization Act (“RICO”) and RICO conspiracy. The Court, after the verdict, needs to enter its findings of fact and conclusions of law regarding equitable disgorgement.
FINDINGS OF FACT
Plaintiff Lynn Creel (“Lynn”) accompanied his wife, Plaintiff Diane Creel (“Diane”) (collectively, “the Creels”), to the Behavioral Hospital of Bellaire (“BHB”) in August 2017. The Creels arrived at BHB planning to receive information on the hospital’s advertised “outpatient group women-centric grief counseling.”
Upon the nurse’s return, the Creels said they were leaving because they did not like the treatment plans that BHB had offered. The nurse informed the Creels that they were not allowed to leave because BHB had “filed an emergency warrant for [Diane’s] detention” and Diane would be placed under a 72-hour hold. The Creels then realized that the BHB medical staff had locked both the door out the front of the building and the door to the intake room. Diane was taken to the psychiatric unit against her will. BHB did not permit Lynn to visit Diane in person. In all this time, neither Lynn nor Diane ever saw the warrant for her detainment or even a shred of paperwork.
The Defendants’ Scheme
The scheme underlying the Creels’ experience began with the business activity of Dr. Yupo Jesse Chang (“Chang”), a family physician who has spent much of his career managing other medical practices. As Chang’s only notary, Yao kept a detailed notary book. The physician recommending commitment of a patient signed off on the notarized documents-but the physician was never physically in front of Yao, the notary, when he or she signed the document.
The notary documents reveal that in just three days between, August 6, and August 10, 2017, a psychiatrist employed by BHB signed applications for the involuntary commitment of twelve different patients.
The Lawsuit
Twelve plaintiffs sued twenty-two defendants, alleging various causes of action based upon their involuntary confinement and stay at BHB. The jury found that Defendants, (1) were employed or associated with a RICO enterprise (2) had participated, either directly or indirectly, in the conduct of the affairs of the enterprise, and (3) had participated through a pattern of racketeering activity. The jury assessed Plaintiffs’ compensatory damages at $300,000.00. The jury also found that all Defendants conspired together to violate RICO.
The jury awarded Diane damages in the amounts of: (1) $75,000.00 for physical pain and mental anguish sustained in the past; (2) $50,000.00 for physical pain and mental anguish that, in reasonable probability, Diane will sustain in the future; (3) $85,500.00 for loss of earning capacity sustained in the past; (4) $104,000.00 for loss of earning capacity that, in reasonable probability, Diane will sustain in the future; (5) $15,000.00 for medical care expenses incurred in the past; and (6) $50,000.00 for medical care expenses that, in reasonable probability, Diane will incur in the future.
Specifically, the Court upheld the jury’s verdict against Defendants for violations of RICO and RICO and is now dealing with disgorgement.
Equitable Disgorgement
Plaintiffs have long pleaded and disclosed a claim for equitable disgorgement in this case. The evidence attributed to equitable disgorgement mostly involves the medical documents that Yao falsely notarized. In January 2017 alone there were 276 documented applications for involuntary patient commitments sent through one of Chang’s companies.
Defendants produced no evidence to suggest they would change their activities following the lawsuit. Despite having had to pay back Medicare and private insurance companies for improper billings, Chang was still conducting his business affairs in the same manner.
The jury awarded $1,320,500 equitable disgorgement.
CONCLUSIONS OF LAW
A claim for disgorgement under the civil RICO statute is an equitable remedy. The jury’s finding on equitable disgorgement under civil RICO is an advisory opinion. The equitable nature of disgorgement requires a court to enter findings of fact and conclusions of law for any amount of the award to stand.
Disgorgement of ill-gotten gains is closely analogous to the equitable remedy of exemplary damages, as the principal purpose is not simply to punish the offending parties for having conspired to make the illicit profits but to convey a strong message, to the conspirators and to third parties alike, that there is yet another disincentive to engaging in such proscribed conduct.
Prevent and Restrain Future Unlawful Conduct
The Court found that the disgorgement in this case is properly sought to “prevent and restrain” Defendants from continuing the unlawful conduct. The conduct that led to this lawsuit was egregious. As previously discussed, in calendar year 2017 alone, hospitals that had contracted with Chang filed 3,955 applications “to hold human beings in psychiatric hospitals against their will.” Chang and Yao were aware this egregious activity was unlawful.
An award of disgorgement of Defendants’ ill-gotten gains will serve to prevent and restrain future illegal conduct. Moreover, the Court found that the jury awarded disgorgement for the purpose of preventing and restraining Defendants’ future conduct.
Calculation of Disgorgement
Before the jury deliberated, Plaintiffs’ most aggressive request for disgorgement was for the jury to multiply $75 by the number of detention warrants in Yao’s notary record for 2017 (3,955). In theory, this would result in a sum for just under $300,000. Inexplicably, however, the jury awarded more than four times that-presumably because it was outraged at Defendants’ conduct.
The Court noted that it was not bound by what the Plaintiffs requested from the jury for disgorgement, just as it is not bound by what the jury awarded. The complex nature of the illegal enterprise in the present matter complicates the calculation of disgorgement.
The Court recognized that Defendants may very well have secured ill-gotten gains that meet or exceed the $1,350,500 awarded by the jury. But there is no evidence of profits that would support such an award. While the Court agreed with Plaintiffs that “[t]here was overwhelming evidence of interactions and communications among [D]efendants showing a common purpose to defraud,” this is not enough.
For the purposes of restraining Defendants’ future conduct, the Court multiplied the cost of a telemedicine visit by Yao’s 3,955 notary book entries from 2017 to calculate Defendants’ profits causally related to their elaborate enterprise. For each telemedicine visit involving involuntary detention, Chang received $75, which comprises a $45 base fee, $5 patient fee, and $25 warrant fee. Multiplying $75 by 3,955, the Court found that the total profit equals $296,625.
Plaintiffs presented no evidence of any other profits derived by Defendants through unlawful conduct that violated RICO, which would support a greater award of disgorgement. For all these reasons, the Court concludes Plaintiffs are entitled to recover from Defendants equitable disgorgement of profits in the sum of $296,625.
ZIFL OPINION
The conduct of BHB and the physicians and nurses involved in this scheme were egregious and used the law to kidnap patients for profit. The disgorgement was a needed addition to the RICO damages to deter future conduct. Since these scofflaws billed Medicare and insurers for the alleged treatment – even if repaid to the insurers and the government – they were perpetrating a fraud that was proved beyond a preponderance. Since, as the court explained, the defendants are still confining people against their will the court should have referred the defendants to the Department of Justice for prosecution.
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 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 55 years in the insurance business. He is available at https://www.zalma.com and [email protected] .
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
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.
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New California Fraud Statutes
SB 1040 , authored by Senator Susan Rubio, authorizes the Insurance Commissioner to order restitution from persons who sell insurance without the necessary license from the Department of Insurance, including “extended vehicle warranties” sold illegally through robocalls and misappropriation of consumers’ and businesses’ premiums, among other insurance scams.
This bill would authorize the commissioner to seek a judgment to enforce an order for restitution. The bill would authorize the commissioner to order a respondent, if certain requirements are met, to provide restitution, as defined, for a loss arising from the respondent’s conduct. With a restitution order, and if the facts and equity permit, the bill would also authorize the commissioner to issue an order of rescission enforceable on any person subject to the commissioner’s jurisdiction. The bill would require the rescission or restitution order to be subject to judicial review.
§12928.6.
(a) Whenever the commissioner believes, from evidence satisfactory to the commissioner, that a person is violating or about to violate this code or an order or requirement of the commissioner issued or promulgated pursuant to authority expressly granted the commissioner by this code or by law, the commissioner may bring an action in the name of the people of the State of California in the superior court of the State of California against the person to enjoin that person from continuing the violation or engaging therein or doing any act in furtherance thereof. In that action, an order or judgment may be entered awarding the preliminary or final injunction as is proper.
(b) (1) The commissioner may apply to the clerk of the superior court for a judgment to enforce an order requiring a person to pay restitution, a monetary penalty, or reimburse the department for costs incurred by the department in prosecuting a matter. The commissioner’s application shall include a certified copy of the order and any associated decision.
(2) Subject to the requirements of paragraph (3), the order and decision shall constitute a sufficient showing to warrant issuance of a judgment in the amount ordered by the commissioner, plus interest. The clerk of the court shall accordingly enter a judgment within five court days.
(3) For an order to qualify for a judgment pursuant to this section, the application shall be accompanied by a declaration given by the legal counsel for the commissioner affirming on information and belief that a petition for mandamus or other legal action for relief from the order has either been denied, or the time for the filing of a petition or action has lapsed.
(4) A judgment entered under this section has the same force and effect as, and is subject to all the laws relating to, a judgment in a civil action, and may be enforced in the same manner as any other judgment of the court in which it is entered.
§ 12928.7.
(a) The commissioner may order a respondent to provide restitution for a loss arising from the respondent’s conduct. If the facts and equity permit, with a restitution order, the commissioner may issue an order of rescission enforceable on any person subject to the commissioner’s jurisdiction. …
§12976.
All fines, forfeitures, taxes, assessments, restitution, and penalties provided for in this code shall be due and payable on the demand of the commissioner. If payment is not made within 10 days after that demand, then the commissioner shall institute an action in the name of the people of the State of California for the purpose of recovering that moneys due. All such actions shall be subject to all the provisions of the Code of Civil Procedure which may be applicable thereto.
SB 1242 , authored by the Senate Committee on Insurance, bolsters anti-insurance fraud efforts essential to protecting consumers from unnecessary economic loss by further clarifying agent-broker anti-fraud education requirements as well as the process by which alleged fraud is reported to the Department of Insurance, in addition to other consumer protection proposals. The Legislative Counsel’s Digest follows:
(1) Existing law establishes a Fraud Division within the Department of Insurance to investigate fraudulent claims. Existing law requires an insurer that reasonably believes or knows that a fraudulent claim is being made to send a prescribed form and additional information about the fraudulent claim to the Fraud Division within 60 days after determination by the insurer that the claim appears to be a fraudulent claim.
This bill would instead require an insurer to send that form and information within 60 days after it that has determined, after the completion of an investigation, that it reasonably suspects or knows an act of insurance fraud may have occurred or might be occurring. The bill would require an agent or broker to use the electronic form within Fraud Division’s Consumer Fraud Reporting Portal before placing an insurance application with an insurer to report if they reasonably suspect or know that a fraudulent application is being made. If the agent or broker reasonably suspects or knows that a fraud has been perpetrated after an insurance application has been placed with an insurer, the bill would require the agent or broker to report that information directly to the insurer’s special investigative unit. The bill would insulate an agent or broker who furnishes this information, or a governmental agency or its employees that furnishes or receives this information or assists in an insurance fraud investigation, from civil liability if they acted in good faith, as specified.
Existing law requires the Department of Justice to maintain state summary criminal history information, authorizes the Department of Justice to furnish that information to another agency, and makes it a crime to furnish that information to an unauthorized person. Existing law regulates the licensing and the renewal of licensing of insurance agents, adjusters, and brokers. Existing law requires an individual to apply with the Insurance Commissioner for a specified license using a form prescribed by the commissioner. Existing law requires specified licensees and applicants for specified licenses to complete a course of study on ethics, which is 12 hours for new applicants and 3 hours before each license renewal for existing licensees. Existing law requires a person licensed to transact specified types of insurance to include their license number on business cards, written price quotations, and print advertisements in a specified type size.
This bill would require the commissioner to submit fingerprint images and related information regarding specified license applicants to the Department of Justice and would require the Department of Justice to provide state or federal criminal history information for each applicant to the commissioner. Because the bill would expand the scope of a crime, the bill would impose a state-mandated local program. On and after March 1, 2023, the bill would require an ethics course for a specified licensee or applicant to include one hour of study on insurance fraud. This bill would require specified licensees to include their license number in the emails the person sends that involve an activity for which a license is required. The bill would set forth size and location requirements for including the license number in an email.
(2)?Existing law requires an insurer to provide a long-term care insurance policyholder or certificate holder a statement with specified information, including that the policyholder or certificate holder may cancel the payment before the payment date, at least 30 days before the first payment of an accelerated death benefit for long-term care. Existing law also requires an insurer to provide a report to a policyholder or certificate holder no later than 30 days after every payment of an accelerated death benefit for long-term care. Under existing law, a loan or withdrawal from the cash value of a life insurance policy that accelerates benefits for long-term care is incomplete until the insurer provides specified information to the policyholder or certificate holder.
This bill would clarify the information that is to be provided in the statement at least 30 days before the expected first payment of an accelerated death benefit for long-term care, would alternatively authorize an insurer to provide the statement at the time of payment if the insurer allows cancellation for at least 30 days after the payment, and would specify the information to be included if the statement is provided at the time of payment. The bill would require an insurer to provide a policyholder or certificate holder with a statement summarizing the effect of the payment on the remaining policy values no later than 30 days after every payment, or 45 days after the first payment, of an accelerated death benefit for long-term care. The bill would authorize an insurer to immediately approve a loan from the cash value of a life insurance policy that accelerates benefits for long-term care if the loan is not treated as a taxable distribution for federal income tax purposes and the insurer permits cancellation of the loan for at least 30 days after the loan payment has been made.
(3)?Existing law requires an insurer to include a written disclosure with contact information of the unit within the Department of Insurance that deals with consumer affairs when a specified policy of automobile, residential property, life, or disability insurance, or a certificate of coverage for a group disability master policy, is first issued to or delivered to a new insured or a new policyholder.
This bill would additionally require that disclosure to be included when a bail bond is first executed or delivered.
Existing law requires an insurer to include a statement indicating that it is a crime to present false and fraudulent information to obtain or amend insurance coverage on a form it uses for an application, policy changes, or making a claim in connection with an insurance application, contract, or provision of contract for liability insurance, or on a rider attached to that form.
This bill would require that statement to appear on the form, exclusive of schedules attached to the form, or an endorsement separate from the form, if used in connection with an insurance application, contract, or provision of contract. The bill would also make conforming changes.
(4)?Existing law requires an insurance pool to furnish a copy of the pool’s annual audited financial statement and most recent actuarial review to specified committees of the Legislature within 180 days of the close of the pool’s fiscal year.
This bill would also require an insurance pool to furnish a copy of that statement and review to the Insurance Commissioner within 180 days of the close of the pool’s fiscal year.
(5) Existing law generally regulates classes of insurance, including disability income insurance. Existing law defines “disability income insurance” to mean insurance against loss of occupational earning capacity arising from injury, sickness, or disablement.
These new statutes control the fraud fight in California and will probably add to the expense incurred by insurers in their efforts to defeat or deter insurance fraud.
Good News From the Coalition Against Insurance Fraud
Dead patients couldn’t stop Thomas G. O’Lear from billing taxpayers $3.7M for fraudulent X-rays in the Indianapolis area. O’Lear ran a portable-X-ray firm that zapped patients in nursing homes, skilled nursing facilities and long-term care facilities. He billed for thousands of X-rays that he and his business did not perform. That included 151 X-rays on dates after the patients had died. He also billed Medicare and Medicaid for services at nursing facilities on dates when patients were either hospitalized and not on-site at the facilities. O’Lear took multiple X-rays in one visit and falsely claimed that each was done on a different day, requiring separate reimbursement for transporting the portable equipment on each date. And he falsely billed for multiple images of patients when only one image was done — thus requiring a higher reimbursement. O’Lear covered up his scheme by forging medical records, falsifying X-ray images and forging signatures of his employees and the doc he said had ordered X-rays.
An accident left Brandi Goldman’s husband — an Army reservist — with a traumatic brain injury while in the service. He was left unable to care for himself. The Jonesboro, Ark. woman siphoned more than $143K of his disability benefits for meth and cronies who sponged off his money. Goldman was appointed as her husband’s guardian. She signed a fiduciary agreement requiring her to spend his disability money on his care. Instead, Goldman spent $150 on meth 2-3 times a week. Five other people also moved into their home. None paid rent, and she regularly gave them?cash from his disability benefits. Goldman also paid $68K in cash for another home, furnishings for the home, plus a vehicle and motor home. And she bought vehicles for several people and gave money to her daughters and her husband’s parents. Goldman received a year and eight months in federal prison.
Both lawmaker and lawbreaker, Robert Goforth ran a pharmacy that billed Medicare and Medicaid $2.7M for prescriptions that customers didn’t pick up. The former Republican state legislator from East Bernstadt, Ky. then multiplied his illicit profits by putting the meds back on the shelf and selling them again. Goforth was handed 25 months in federal prison. He also was earlier convicted of domestic violence against his wife, receiving 59 days. And Goforth agreed earlier this year to pay $22K of fines for campaign finance and ethics violations relating to his 2020 campaign. He abruptly resigned his state House seat in August 2021, citing “family and personal circumstances.”
Ohio has yanked the license of an attorney who repeatedly avoided paying nearly $960K of workers comp premiums owed by his housecleaning firms. Robert Fitz was under interim suspension until the state Supreme Court grew fed up with his lack of repayment after being convicted. At first Fitz had coverage for 12 housecleaning firms through the Ohio Bureau of Workers’ Compensation. He bought coverage for one company, RCF Licensing, in 1991 then stopped paying premiums in 2003. BWC advised him it was illegal to operate a business without proper comp coverage. Fitz said he was trying to reinstate his coverage. Then in 2013, BWC discovered that policies for several of his firms had lapsed or been canceled. The bureau consolidated the policies and presented Fitz with a payment plan to catch up premiums he owed. Fitz didn’t bring the coverage into compliance or pay up. He pled guilty to a misdemeanor. Then BWC discovered Fitz hadn’t kept coverage for another housecleaning firm and owed $936K of premiums. He received five years of community control in 2019 yet still wasn’t repaying much of the money he owed for all his firms. Enough already, the Supreme Court ruled. Fitz can seek to reinstate his license in two years.?
An insurance adjuster stole nearly $30K and the IDs of four victims of gas explosions that ripped through the valley in 2018, officials charge in the Jackson, Miss. area. The explosions devastated the Merrimack Valley region, leaving thousands of people and businesses without heat and hot water in the cold winter months. Lashaunda Studaway handled victim claims for Columbia Gas, which reached a $56M agreement with the state for its role in the gas explosions and fires. She stole the IDs of four victims, then dispersed pre-paid debit cards to herself instead of to the victims. Studaway made false insurance claims under a real claimant’s file or created files using a fake person’s name.
An aide to an Alabama U.S. Congressman was jailed on health-fraud charges after serving time for a prior fraud conviction. Sherry McCormick works for U.S. Rep. Barry Moore (R-Enterprise) as head of special constituent services and events. Details of the latest charges have yet to be publicly revealed. McCormick received eight months in federal prison after pleading guilty in 2018 to making nearly $500K of false claims for compound pain and scar meds that weren’t medically needed, not prescribed by a doc, and weren't even provided to patients. A pharmacy paid McCormick a kickback percentage of each claim paid by Medicare or TriCare, the insurance program for military members and vets. She also was ordered to repay $447.7K. McCormick is on administrative leave for the latest charges. We’ll keep updated as more charges are known.
Some 178 medical providers have been kicked out of California’s workers’ comp system during the first eight months of 2022, the state Division of Workers’ Compensation says. A total of 649 providers have been booted since 2017. DWC also has begun new lien-consolidation cases estimated at $75M for producers convicted of fraud crimes so far this year. During lien hearings, medical providers have an opportunity to prove the billing is legitimate. The liens are dismissed if the providers can’t produce the evidence. A total of 63K liens have been dismissed since 2017, with a value of nearly $775M. There are currently 86 criminally charged providers with 516K liens designated as stayed. The stays prevent criminally charged providers from seeking payment for their liens while the criminal case is pending.
A new restitution law is now on the books in California after a Senate Bill was signed into law by Governor Gavin Newsom. The new law increases the powers of the California Department of Insurance to seek restitution for those found to have committed fraudulent acts. The commissioner is now authorized to seek a court judgment to enforce an order for restitution and, subject to judicial review, the commissioner may also issue an order of rescission enforceable on any person or company subject to the commissioner’s jurisdiction.
A prominent, free-spending socialite and Republican fundraiser outside Philadelphia, she was convicted of inflating $20M of claims for jewelry, a large ceiling mural, expensive draperies and other goods after mysterious fires broke out at her 5.6K-square-foot mansion. She received up to 23 months in 2016. Risoldi has been free while appealing. Her latest gambit was to seek freedom under a non-existent reentry program. The judge?said no and ordered Risoldi to her jail cell. About her false claims: Risoldi was never charged with arson, though she piled up sooty fire claims afterward. Her biggest insurance gambit involved $10M of supposedly stolen jewelry after the third and final fire in October 2013. Risoldi inflated the policy from $100K on two pieces of jewelry to more than $10M for 55 pieces — just three months before that fire. She forged jewelry appraisal documents, repeatedly misspelling the word “jewelry.” Volunteer firefighters put their lives on the line for her home. Yet Risoldi accused them of stealing the jewelry while they worked to tamp down the flames inside. Then an insurance adjuster found a canvas jewelry bag hidden behind a grandfather clock in the burned dining room, and another bag in a bathtub days after the fire. The empty jewelry boxes in the bags had no soot or signs of water or soot damage.
A surgeon did worthless and unneeded back surgeries on homeless and addicted people so a slip-and-fall ring could exploit them to maximize $31M of insurance payouts. Dr. Sady Ribeiro pled federally guilty. The ring recruited more than 400 patients in the New York City area. The patients were coached to lie that they tripped, fell and were hurt at pre-set locations. Sometimes they deliberately fell at sites such as cellar doors, cracks in concrete sidewalks, and purported “potholes.” The supposedly injured patients were referred to colluding personal-injury attorneys, who falsely sued the site owners and their insurers. The patients were also told to receive ongoing chiro and other treatment from certain chiropractors and docs, including Ribeiro. To continue with their lawsuits, the patients had to undergo two back surges. They were paid token sums $1K- $1.5K after they completed surgery. The patients were desperate — addicted or recruited from homeless shelters. Many had to ask for food when they met with the lawyers. Often, they didn’t have clothing to stay warm during the winter and had poor-quality shoes. Litigation-funding companies financed the fraudulent lawsuits. “I will play a very honest ‘game’ with you. … I see the patient and I generate a very good dictation that justifies the treatment-there is a cost for that, and I hope a profit,” Ribeiro emailed litigation-funding attorney Adrian Alexander. Ribeiro will serve up to five years and must forfeit $513K. Alexander earlier pled guilty and could receive five years when sentenced.
A string of home fires helped unravel a $1M arson ring, officials charge in Youngstown, Ohio. Johnny and Kyrene Rodriguez bought a run-down house at auction for $5K in 2012 and bought a policy worth far more than the home’s value. They only occasionally stayed there. The house mysteriously burned to ashes in 2015, earning them a $336.5K insurance payout. Investigators determined the fire was arson. Rodriguez assembled a seven-person crew that helped torch several more buildings, defrauding Allstate, State Farm and Nationwide. The gang also branched out. They were involved with counterfeit money changing of $1 bills into $20, $50 and $100 bills; hiding from the Social Security Administration a mineral-rights windfall so that more than $30,000 in benefits could be collected; and burglarizing a home intending to destroy evidence about their alleged crimes. Rodriguez pled guilty and will be sentenced later. His suspected cohorts face trial.
Andiamo’s restaurant was hemorrhaging money in Orange County, N.Y. Owner Zef Gjurashaj told his niece Marina Gjurashaj to start the fire by removing a plug from a propane line in the kitchen, spraying a flammable liquid on the floor, then opening the propane line and lighting the liquid. The fire was so intense that it put the firefighters, and Gjurashaj’s wife, who was onsite during the fire, at grave risk of death. The restaurant was gutted. Right after the blaze, Gjurashaj told reporters he felt “heartbreak” and was committed to rebuilding the building. The restaurant “means a lot because whatever we have in our life we have from this place,” he said. Gjurashaj gave his insurer fraudulent proof of loss, sought fire-damage payment and lied under oath about how the fire started. He faces 25 years to life when sentenced in December. Marina will be sentenced later. Gjurashaj also unreported cash income from the restaurant as part of his state tax filings.
Justin Perez-Gorda was severely wounded and paralyzed from the waist down while serving in Afghanistan, the San Antonio, Tex.-area vet claimed. Perez-Gorda was declared disabled and received $300K of federal disability money over nearly six years. A charity for wounded vets called Homes for Our Troops even gave him and his wife Josephine a specially equipped home. Investigators wised up and tailed Perez-Gorda. He was caught playing basketball and walking without assistance. Perez-Gorda died several years ago, though Josephine was recently convicted of faking his medical condition by filling out false federal disability paperwork. Among other things, she wrote he was “paralyzed from the belly button down.” Josephine was convicted and will be sentenced in December. She could serve up to 10 years on each of several federal counts.
Co-workers grew concerned when Chad Entzel didn’t return to work after the holiday season. The Bismarck, N.D. a man was found naked and dead on his bedroom floor, shot twice with a shotgun. Turns out his wife Nikki Sue and Earl Howard were having an affair. They somehow thought investigators would believe Chad needed to shoot himself twice with a shotgun in a bloody suicide. The pair wanted to score $600K of life insurance. Nikki also bought a $26K renter policy two weeks before Chad died. Nikki and Earl?positioned a heater near Chad’s bed, hoping it would catch fire. When it didn’t, they returned to reposition the heater and tried again. Officials discovered a small fire atop a basement furnace — a flabby arson bid. Nor did she seem concerned about Chad’s going missing. She told his co-workers that she didn’t have time to look for him when they reached out, worried about him. Yet she wasn’t too busy to call the insurer about the policy payouts within days of Chad’s murder. Whiskey bottles were also found at the death scene. Nikki staged the bottles to make Chad seem like an abusive alcoholic. Earl pled guilty, Nikki still faces trial, with up to life in prison if convicted.
Insurer Takes the Profit out of Fraud
Insured’s Suit for Fire Insurance Benefits Defeated by Qui Tam Claim by Insurer
In Lisa A. McCullough v. Metlife Auto & Home, No. 4:20-CV-01807, United States District Court, M.D. Pennsylvania (September 30, 2022) McCullough sued seeking to force MetLife to pay Plaintiff for an insurance policy on the McCullough’s home, which was destroyed in a fire in 2019.
BACKGROUND
MetLife moved the case to the USDC and filed an answer to complaint, along with a counterclaim against Plaintiff for insurance fraud. MetLife served the counterclaim on Plaintiff’s attorney that same month, alleging insurance fraud under Pennsylvania law.?Plaintiff failed to respond to the counterclaim. In March 2021, MetLife moved for entry of default against Plaintiff, and default was subsequently entered by the Clerk of Court.
MetLife moved for a default judgment. In January 2022, this Court granted MetLife’s motion and requested briefing and evidence of any damages sought by MetLife. MetLife has submitted a brief and evidence listing its damages. MetLife has additionally moved for judgment on the pleadings pursuant to Federal Rule of Civil Procedure 12(c). For the following reasons, MetLife’s Rule 12(c) motion will be granted and its motion for a default judgment will be granted in part and denied in part.
DISCUSSION
When considering a motion for judgment on the pleadings a court assumes the truth of all factual allegations in the plaintiff’s complaint and draws all inferences in favor of that party. It does not, however, assume the truth of any of the complaint’s legal conclusions
Pennsylvania law provides that an individual commits the offense of insurance fraud if she “[k]nowingly and with the intent to defraud any insurer or self-insured, presents or causes to be presented to any insurer or self-insured any statement forming a part of, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim.”
Although these elements are set forth in a criminal statute, the statute further allows aggrieved insurers to file a civil action against violators of the statute “to recover compensatory damages, which may include reasonable investigation expenses, costs of suit and attorney fees.”
Additional facts indicated that Plaintiff set the fire, such as her relocation of important documents before the fire and the discovery of newly purchased gas cans with residual gasoline in them at her home, after the fire. Plaintiff “submitted a claim to Defendant for the alleged loss as a result of the fire,” thereby presenting “false, incomplete and/or misleading information concerning the claim and the cause of the fire.”
As Plaintiff has not appeared before the Court, the Court, by rule of practice, must conclude that there are no disputed material facts. MetLife’s factual allegations lead to a reasonable inference that Plaintiff committed insurance fraud. Accordingly, MetLife’s motion under Rule 12(c) was granted.
MetLife’s Damages
Having found that MetLife has satisfactorily alleged a civil claim for insurance fraud, the Court now considers its damages. MetLife seeks $26,069.01 in “pre-suit investigation costs.” It has provided the Court with invoices for the firms hired to investigate the fire in McCullough’s home to support its request for pre-suit costs. The Court found this evidence sufficient to award the pre-suit costs without an evidentiary hearing.
MetLife also sought “$29,998.04 in litigation costs of suit and attorney fees” for a total of $56,067.05.
Here, the invoices MetLife submitted do not indicate if multiple attorneys worked on this matter or only William J. McPartland, Esq. Additionally, the invoices do not explain how many hours were billed for or the hourly rates for Mr. McPartland and any other attorneys working on the matter. Nor are there affidavits to substantiate those hourly rates as the prevailing market rates in the community. Without this information, the Court cannot determine a reasonable fee for counsel’s efforts.
Accordingly, MetLife’s motion for a default judgment is granted in part and denied in part with respect to the damages it seeks, and the court offered to reconsider if provided sufficient detail concerning the attorney’s fees sought.
ZIFL OPINION
Insurance fraud, especially an arson for profit, are both crimes and defenses to breach of contract claims by the insured arsonist. When Met Life filed its cross-claim the insured and her counsel saw the writing on the wall and refused to participate. As a result, the insurer obtained a judgment against the insured which may or may not be collectible. The judge, with a finding of fraud, should have referred the case to the local U.S. Attorney for prosecution.
A Resource for the Insurance Professional
After practicing insurance law for over five decades, Barry Zalma , an internationally recognized and award-winning insurance expert and author, is releasing multiple education books on Amazon.com . The publications are designed to inform claims people, special investigation unit investigators, coverage lawyers, plaintiffs’ bad faith lawyers, insurance management and the insurance buying public on insurance claims procedures and insurance fraud. Each resource leverages key insights and learnings from Zalma’s 55+ years of practical experience as a claims person and insurance coverage attorney.
To be an insurance professional requires continuous learning. That’s the motivation behind my writing; I have felt a need to share my experiences to help people in the industry learn how to properly handle claims and avoid accusations of the tort of bad faith.”?See his latest interview for new adjusters at https://player.fm/series/daily-claims/episode-11-advice-for-new-and-aspiring-adjusters .
Visit Zalma’s Insurance Claims Library to view all publications that can be purchased through Amazon as Paperback and Kindle e-books. A selection of the books available include:
·????????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 4300 digests of recent appellate court opinions and more than 81 videos dealing with true crime stories of insurance fraud.
·????????In addition to the free materials, for a paid subscription of only $5 a month or $50 a year to Zalma on Insurance at Locals.com you or your staff of claims personnel can receive important, more detailed and informative information needed by everyone interested in insurance, insurance claims, insurance law or insurance fraud.
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Zalma on Insurance at Locals.com - Excellence in Claims Handling
Create a Staff of Professional Claims Handlers
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.
In addition to the free materials, for a paid subscription of only $5 a month or $50 a year to Zalma on Insurance at Locals.com you or your staff of claims personnel can receive important, more detailed and informative information needed by everyone interested in insurance, insurance claims, insurance law or insurance fraud.
Each video will run from five to twenty minutes and can be viewed by each claims person with a first cup of coffee or glass of orange juice once or multiple time if desired.
How to Subscribe to Zalma on Insurance and Excellence in Claims Handling
To gain access to the special materials you can Subscribe to Zalma on Insurance at locals.com Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe .
The Locals.com community is called Zalma on Insurance and is a community created by Barry Zalma, Esq., CFE and ClaimSchool, Inc. to help create a community of insurance professionals dedicated to excellence in claims handling.
Zalma on Insurance will provide materials on insurance, insurance claims, insurance law and insurance fraud. Some material, like the daily blog posting, will be presented free while the Excellence in Claims Handling will require a Locals subscription.
Excellence in Claims Handling will be a source for the insurance claims person to become an insurance claims professional who can provide excellence in claims handling to the insurance buying public locals.com https://zalmaoninsurance.locals.com/subscribe .
领英推荐
Become a Professional Claims Handler
In search of profit, insurers have decimated their professional claims staff. They laid off experienced personnel and replaced them with young, untrained, unprepared people. A virtual clerk replaced the old professional claims handler. Process and computers replaced hands-on human skill, empathy and judgment. Money was saved by paying lower salaries. Within three months of firing the experienced claims people gross profit increased.
The promises made by an insurance policy are kept by the professional claims person. Keeping a professional claims staff dedicated to excellence in claims handling is cost-effective over long periods of time. A professional and experienced adjuster will save the insurer millions by resolving disputes, paying claims owed promptly and fairly, and by so doing avoid litigation.
The professional claims person is an important part of the insurer’s defense against litigation by insureds against insurers for breach of contract and the tort of bad faith. Claims professionals resolve more claims for less money without the need for either party to involve counsel. A happy insured or claimant satisfied with the results of his or her claim will never sue the insurer.
Insurers who believe they can professionally, fairly, and in good faith with young, inexpensive, inexperienced and untrained claims handlers should be accosted by angry stockholders whose dividends have plummeted or will plummet as a result. When an insurer compromises on staff, profits, thin as they may have been previously, will move rapidly into negative territory. Tort and punitive damages will deplete reserves. Insurers will quickly question why they are writing insurance. Those who stay in the business of insurance will either adopt a program requiring excellence in claims handling from every member of their claims staff, or they will fail.
Insurance is a business that must change if it is to survive. Insurers must rethink the firing of experienced claims staff and reductions in training to save “expense.” Insurers should, if they wish to succeed, adopt a program to promote excellence in claims handling that can help insurers keep the promises made by the insurance policy and avoid charges of breach of contract and the tort bad faith in both first and third party claims.
INSURER AWARDED DAMAGES FOR FRAUD
Insured’s Suit for Fire Insurance Benefits Defeated by Qui Tam Claim by Insurer
In Lisa A. McCullough v. Metlife Auto & Home, No. 4:20-CV-01807, United States District Court, M.D. Pennsylvania (September 30, 2022) McCullough sued seeking to force MetLife to pay Plaintiff for an insurance policy on the McCullough’s home, which was destroyed in a fire in 2019.
BACKGROUND
MetLife moved the case to the USDC and filed an answer to complaint, along with a counterclaim against Plaintiff for insurance fraud. MetLife served the counterclaim on Plaintiff’s attorney that same month, alleging insurance fraud under Pennsylvania law.?Plaintiff failed to respond to the counterclaim. In March 2021, MetLife moved for entry of default against Plaintiff, and default was subsequently entered by the Clerk of Court.
MetLife moved for a default judgment. In January 2022, this Court granted MetLife’s motion and requested briefing and evidence of any damages sought by MetLife. MetLife has submitted a brief and evidence listing its damages. MetLife has additionally moved for judgment on the pleadings pursuant to Federal Rule of Civil Procedure 12(c). For the following reasons, MetLife’s Rule 12(c) motion will be granted and its motion for a default judgment will be granted in part and denied in part.
DISCUSSION
When considering a motion for judgment on the pleadings a court assumes the truth of all factual allegations in the plaintiff’s complaint and draws all inferences in favor of that party. It does not, however, assume the truth of any of the complaint’s legal conclusions
Pennsylvania law provides that an individual commits the offense of insurance fraud if she “[k]nowingly and with the intent to defraud any insurer or self-insured, presents or causes to be presented to any insurer or self-insured any statement forming a part of, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim.”
Although these elements are set forth in a criminal statute, the statute further allows aggrieved insurers to file a civil action against violators of the statute “to recover compensatory damages, which may include reasonable investigation expenses, costs of suit and attorney fees.”
Additional facts indicated that Plaintiff set the fire, such as her relocation of important documents before the fire and the discovery of newly purchased gas cans with residual gasoline in them at her home, after the fire. Plaintiff “submitted a claim to Defendant for the alleged loss as a result of the fire,” thereby presenting “false, incomplete and/or misleading information concerning the claim and the cause of the fire.”
As Plaintiff did not appear before the Court, the Court, by rule of practice, must conclude that there are no disputed material facts. MetLife’s factual allegations lead to a reasonable inference that Plaintiff committed insurance fraud. Accordingly, MetLife’s motion under Rule 12(c) was granted.
MetLife’s Damages
Having found that MetLife satisfactorily alleged a civil claim for insurance fraud, the Court then considered its damages. MetLife sought $26,069.01 in “pre-suit investigation costs.” It has provided the Court with invoices for the firms hired to investigate the fire in McCullough’s home to support its request for pre-suit costs. The Court found this evidence sufficient to award the pre-suit costs without an evidentiary hearing.
MetLife also sought “$29,998.04 in litigation costs of suit and attorney fees” for a total of $56,067.05.
The invoices MetLife submitted did not indicate if multiple attorneys worked on this matter or only William J. McPartland, Esq. Additionally, the invoices did not explain how many hours were billed for or the hourly rates for Mr. McPartland and any other attorneys working on the matter. Nor are there affidavits to substantiate those hourly rates as the prevailing market rates in the community. Without this information, the Court could not determine a reasonable fee for counsel’s efforts.
Accordingly, MetLife’s motion for a default judgment was granted in part and denied in part with respect to the damages it sought, and the court offered to reconsider if provided sufficient detail concerning the attorney’s fees sought.
ZIFL OPINION
Insurance fraud, especially an arson for profit, are both crimes and defenses to breach of contract claims by the insured arsonist. When Met Life filed its cross-claim the insured and her counsel saw the writing on the wall and refused to participate. As a result, the insurer obtained a judgment against the insured which may or may not be collectible. The judge, with a finding of fraud, should have referred the case to the local U.S. Attorney for prosecution.
Health Insurance Fraud Convictions
Doctor Admits Illegally Prescribing 120,000 Opioid Pills
Dr. Dzung Ahn Pham of Tustin, California pleaded guilty to writing prescriptions for more than 120,000 opioid pills over a six-year span, including to an impaired driver who struck and killed a bicyclist.
In his plea agreement, Dr. Pham admitted distributing the pills without a legitimate medical purpose in exchange for cash and insurance payments. He pleaded guilty in October to conspiracy to distribute controlled substances, the Orange County Register reported.
Pham faces up to 20 years in federal prison when he is sentenced on Jan. 6, 2023.
From Jan. 1, 2013 and Dec. 17, 2018, Pham wrote prescriptions for around 53,000 Oxycodone pills, 68,000 hydrocodone pills and 29,000 pills of amphetamine salts using 18 different patient names, according to his plea agreement.
Pham’s record of prescribing large amounts of pills led a CVS pharmacy to stop accepting prescriptions from him when he couldn’t justify the number of pills patients were picking up, prosecutors said when charges were filed in 2018.
Pham conspired with Jennifer Thaoyen Nguyen, 51, a licensed pharmacist who also has agreed to enter a guilty plea for the same felony charge later this month, court records show. Pham directed his patients to Nguyen’s pharmacy to fill his prescriptions because he knew other pharmacies would not, according to court documents.
A man who fatally struck an off-duty firefighter training on his bike for a triathlon told investigators he was on drugs prescribed by Pham. Several prescription bottles with Pham’s name were found in the driver’s car. Stephen Scarpa, the person to whom Pham prescribed the opioids was convicted of second-degree murder in the death of Costa Mesa fire Capt. Mike Kreza. Pham was not charged in the death.
Home Health Care Company Owners Sentenced for $6.7 Million Health Care Fraud
Patricia Omorogbe, 61, of Lansing, a registered nurse, was sentenced to two years in prison. Felix Omorogbe, 71, of Lansing, was sentenced to 18 months in prison. Patricia Omorogbe was also ordered to pay $6,643,094 in restitution. Felix Omorogbe was ordered to pay $1,592,362 in restitution. The two Illinois home health care company owners were sentenced September 29, 2022 as part of a $6.7 million home health care fraud scheme.
According to court documents, the Omorogbes owned and operated three home health companies:?A&Z Home Health Care and Dominion Home Health Care, both located in Lansing, and Alliance Home Health Care, located in Hammond, Indiana. From approximately January 2009 to June 2018, the Omorogbes secretly paid bribes and kickbacks to patient marketers in exchange for referrals of Medicare beneficiaries to the companies.
Patricia Omorogbe maintained relationships with marketers and signed sham contracts with patient marketers on behalf of the companies, while Felix Omorogbe facilitated kickback payments to marketers by writing checks to himself and agency employees, who would then convert the checks to cash that was used to pay kickbacks to marketers. Patricia Omorogbe caused fraudulent claims to be submitted to Medicare for home health services that falsely represented that she, as a registered nurse, performed assessments of patients on dates when she was out of the country. It was the practice of the Omorogbes’ companies to admit, discharge, and re-certify certain patients repeatedly, regardless of their medical conditions.?
President of Radiology Services Company Sentenced to 15 Years in Prison for $2 Million Healthcare Fraud Scheme and Identity Theft
Thomas G. O’Lear, 58, of North Canton, Ohio, was sentenced on Thursday, September 29, 2022, by U.S. District Judge Dan Polster to 15 years in prison and was ordered to pay $1,989,490 in restitution to Medicare, Medicaid and two Medicaid Managed Care Organizations (MCOs). Judge Polster pronounced the sentence after O’Lear was convicted at trial of defrauding Medicare and Medicaid of approximately $2 million by billing for x-ray-related services that his company did not provide, engaging in a cover-up scheme to conceal the fraud and committing aggravated identity theft.
According to court documents and evidence presented at trial, O’Lear was President of Portable Radiology Services (PRS), a company that provided portable x-ray-related services to individuals residing in nursing homes, skilled nursing facilities and long-term care facilities.
From 2013 through 2017, O’Lear submitted false claims for reimbursement to Medicare, Medicaid and MCOs for thousands of x-rays and related services that he and his business did not provide, including approximately 151 x-ray services purportedly provided to patients on dates after the patients had died. Of course, nobody needs X-rays after they’re dead, and the taxpayers shouldn’t have to pay for them.
Evidence also proved that O’Lear billed Medicare and Medicaid for purportedly having provided x-ray-related services to beneficiaries at nursing facilities on dates when the beneficiaries were hospitalized and not at the facilities. In another aspect of the fraud, O’Lear took multiple x-rays that had all been performed in one visit and falsely claimed that each one had been done on a different day, requiring separate reimbursement for transporting the portable x-ray equipment on each date. Similarly, O’Lear falsely billed for taking multiple images or views of patients when only one view had been done, thereby requiring a greater reimbursement.?
During an audit by a Medicaid MCO, O’Lear covered up the scheme and committed aggravated identity theft by creating false medical records, including forms for ordering x-rays and radiology reading reports. He even falsified x-ray images but was found to have re-used the same image repeatedly as different images of the same patient and even as images of different patients. In creating the falsified order forms, he forged the signatures of his employees and the physician he said had ordered the x-rays.
As a result of the scheme, court documents state that O’Lear submitted fraudulent bills to Medicare, Medicaid and Medicaid MCOs for approximately $3.7 million and received approximately $2 million in payments as a result of fraudulent bills.
Former Certified Nurse Practitioner Pleads Guilty to Drug Diversion and Health Care Fraud
Larry J. Goisse, Jr., 38, of the Pittsburgh’s Mt. Washington neighborhood, pleaded guilty to six counts on October 5, 2022 before Senior United States District Judge Nora Barry Fischer. Goisse’s guilty plea included one count of an Indictment charging him with drug diversion, and five counts of an Information charging him with health care fraud.
In connection with the guilty plea, the court was advised that in September and October 2018, Goisse, a former certified nurse practitioner, continued to prescribe Adderall and submit claims to Medicare for office visits under a co-worker’s license after his nursing license was suspended.
Judge Fischer scheduled sentencing for Jan. 19, 2023 at 9:30 a.m. The law provides for a total sentence of not more than 30 years in prison, a fine of $1,250,000, or both. Under the Federal Sentencing Guidelines, the actual sentence imposed is based upon the seriousness of the offenses and the prior criminal history, if any, of the defendant.
Owner of Northeast Philadelphia Pharmacy Sentenced to 3 ? Years for Conspiracy to Distribute Oxycodone and Fraud
The Pharmacy and Pharmacist also agreed to resolve a Civil Fraud and Controlled Substance Liability Lawsuit for Over $4 Million
Mitchell Spivack, 63, of Collegeville, PA, was sentenced to three years and six months in prison, two years of supervised release, and ordered to pay $451,328 restitution and to forfeit $116,000 by United States District Court Judge Harvey Bartle III, for conspiracy to distribute controlled substances and healthcare fraud. These charges were the result of a joint investigation between the United States Attorney’s Office for the Eastern District of Pennsylvania and the Pennsylvania Office of Attorney General.
In June 2022, the defendant pleaded guilty to a Criminal Information charging him with these offenses. According to the charging documents, Spivack owned Verree Pharmacy, a small neighborhood pharmacy located in the Fox Chase section of Philadelphia and was the pharmacist in charge for more than thirty years. During that time in business, Spivack and his coconspirators allegedly cultivated Verree’s reputation as a “no questions asked” pharmacy for oxycodone and other dangerous and addictive opioid drugs. By 2016, Verree was the largest purchaser of oxycodone among retail pharmacies in the entire Commonwealth of Pennsylvania. In furtherance of the conspiracy, Spivack and his coconspirators filled prescriptions for wholesale quantities of high-dose oxycodone despite obvious alterations to the prescriptions and other red flags indicating that the drugs were not for a legitimate medical purpose. In addition, Spivack and other employees of Verree submitted entirely fraudulent claims to health care benefit programs for prescription drugs not dispensed. These drugs were designated in patient profiles as “BBDF” which was an acronym for “Bill But Don’t Fill.” From 2013 through 2019, Medicare and other insurers paid over $450,000 for these bogus claims.
In August 2022, U.S. Attorney Romero announced that the United States filed a civil judgment with Philadelphia-based Spivack, Inc., previously operating under the name Verree Pharmacy, and defendant Spivack, to resolve allegations similar to the criminal charges. The pharmacy and Spivack have agreed to pay over $4.1 million to resolve their civil liability under the Controlled Substances Act, False Claims Act, and forfeiture. The judgment also permanently bans them from ever dispensing controlled substances in the future.
Jacksonville, Florida Health Care Provider Physicians Group Services Agrees To Pay $700,000 To Resolve Civil Healthcare Fraud Allegations
Physicians Group Services, P.A. (“PGS”) has agreed to pay the United States and the State of Florida $700,000 to resolve allegations that PGS violated the False Claims Act by submitting false or fraudulent claims to the Florida Medicaid Program, which is a state and federal partnership that provides access to health care coverage for low-income families and individuals in Florida.
The United States’ investigation focused on urine drug testing (“UDT”) by PGS. UDT occurs in a variety of health care settings. In a pain management practice, UDT is used to monitor whether a patient is taking prescribed drugs, is taking non-prescribed drugs, or is consuming with prescribed drugs other dangerous substances, such as alcohol. UDT is either “qualitative” or “quantitative.”
The clinical value of quantitative UDT depends in part on whether the qualitative UDT result is expected or unexpected, as well as the patient’s history of drug abuse, history of medication adherence and compliance, clinical presentation, and medical history. The settlement announced today resolves allegations that PGS submitted claims to Florida Medicaid for quantitative urine drug testing, which claims the United States and the State of Florida allege were medically unnecessary because the testing was not individualized to the particular needs of the patient.
Pharmacy Owner Pleads Guilty in Healthcare Fraud Scheme
James Craig Bell, 63, pleaded guilty October 6, 2022 to conspiracy to defraud Medicare, North Carolina Medicaid, and private health insurers through his pharmacy in Red Springs, North Carolina, that operated under the name Townsend’s Pharmacy.
According to the criminal information and evidence summarized in Court, beginning as early as 2006 through July 2017, Bell, acting through Townsend’s Pharmacy, billed Medicare, Medicaid, and various private health plans for prescription drugs that were never actually dispensed by the pharmacy.
Bell conspired with his employee, Melisha West, 51, of Raleigh. West began independently running the pharmacy’s operations while Bell continued to knowingly profit from the fraudulent billing practices. West pleaded guilty to Healthcare Fraud in January 2022 for her role in the scheme and her sentencing hearing is set for the January 3, 2023 term of court. Bell had trained West and other employees on how to bill health care benefit plans for drugs that were not authorized or dispensed. Bell also trained employees to falsely reauthorize a previously existing prescription from a licensed medical professional, and, how to falsely bill health care benefit programs as though a drug had been dispensed.
Bell pleaded guilty to Conspiracy to Commit Healthcare Fraud. He faces up to 10 years in prison and a potential fine. Sentencing before United States District Judge Louise W. Flanagan is scheduled to occur early next year.
Sentenced to 30 Months, Ordered to Repay $7.5 million For Health Care Fraud Scheme
Jamie McCoy, 42, pleaded guilty on Nov. 23, 2020 to three felony counts: health care fraud, making false statements related to health care matters and offering and paying illegal kickbacks for referrals. He admitted owning or operating companies that supplied orthotic braces and other durable medical equipment (DME): AE Wellness LLC, Summit Medical Supply, Patriot Medical Supply and DME Device Co.
U.S. District Judge Stephen N. Limbaugh on Thursday sentenced McCoy to 30 months in prison for health care fraud and ordered him to repay $7.5 million.
McCoy contracted with marketing firms who placed ads on television and online that offered orthotic braces at no cost. The companies sent patient information to a telemedicine doctor who signed an order for medical equipment without evaluating or even communicating with the patient in some cases, McCoy’s plea agreement says. Those leads, consisting of the patient information and the medical equipment order, were then sold to DME companies.
McCoy admitted paying 70% to 80% of his profits to one person who supplied leads to AE Wellness. Another received $35-40 for leads without a doctor’s order and $280-$300 for a “full lead.”
From September 2016 to August 2017, AE Wellness submitted $6 million in reimbursement claims to Medicare for DME and $67,955 to Tricare. Patriot Medical Supplies billed Tricare $23,951. McCoy admitted knowing Medicare, Medcaid and Tricare, which reimburses for health care services provided to current and former members of the military and their families, would not pay for items obtained by paying illegal kickbacks.
After AE Wellness was suspended in 2017 for paying illegal kickbacks, McCoy, AE’s office manager Brandy McKay and Jackson Preston Siples III, who ran day-to-day operations at AE, opened new DME companies. They concealed McCoy’s role, and continued to pay kickbacks for referrals and leads, McCoy’s plea agreement says.
From June 5, 2018 to March 21, 2019, McCoy and McKay submitted $1.8 million in fraudulent reimbursement claims to Medicare and $15,540 to Tricare on behalf of a company known as MC Medical. From March 8, 2018 to March 13, 2019, Siples submitted $6 million in fraudulent reimbursement claims to Medicare and $145,614 to Tricare on behalf of a company known as Integrity Medical Supply. Siples submitted $922,562 in false claims to Medicare from March 5, 2019 to Match 27, 2019 on behalf of Radiance Health Group.
McKay went on to manage a series of companies that continued the scheme.
McKay was sentenced Jan. 18, 2022 to three years in prison and ordered to repay $7.5 million. Siples pleaded guilty in May to the same charges as McCoy and is awaiting sentencing.
Pediatric Dentist and Affiliated Practices to Pay Over $750,000 to Resolve False Claims Act Allegations
Pediatric Dentist Barry L. Jacobson and his company, HQRC Management Services LLC (HQRC), along with 13 affiliated pediatric dentistry practices, agreed to pay $753,457 to resolve allegations that they violated the False Claims Act by allegedly performing and billing for medically unnecessary therapeutic pulpotomies on pediatric patients.
The settlement, which is the result of a joint investigation between the U.S. Attorney’s Office for the District of New Jersey and the New York Attorney General’s Medicaid Fraud Control Unit (MFCU), also resolves allegations that defendants provided inaccurate servicing provider information on claims submitted to Medicaid managed care organizations.
According to the contentions of the United States contained in the settlement agreement:
Jacobson is the chief executive officer of HQRC, now doing business as PDS Management Solutions. He is also the founder and owner of the following New York and New Jersey based Pediatric Dentistry Practices party to the agreement: Pediatric Dentistry of Paterson, Pediatric Dentistry of Teaneck, Pediatric Dentistry of Wykoff, Pediatric Dentistry of Flushing, Pediatric Dentistry of the Bronx, Pediatric Dentistry of Valley Stream, Pediatric Dentistry of Brooklyn (Avenue U), Pediatric Dentistry of Brooklyn (Boro Park), Pediatric Dentistry of Monsey, Pediatric Dentistry of Kingston, Pediatric Dentistry of Albany, Pediatric Dentistry of Malone, and North Country Pediatric Dentistry.
The settlement resolves allegations that HQRC dentists performed medically unnecessary therapeutic pulpotomies on pediatric patients. According to the United States, certain dentists performed therapeutic pulpotomies on primary teeth even though there was no dental decay in the inner third of the dentin. The defendants also provided inaccurate servicing provider information on claims for services submitted to New York and New Jersey Medicaid Managed Care Organizations.
Jacobson and the affiliated corporate defendants admit that, in some instances between 2011 and 2018, some dentists affiliated with HQRC performed and billed Medicaid for pulpotomies not supported by the medical records maintained at the respective HQRC affiliated dental practices. The defendants also admit that in some instances, between 2011 and 2014, HQRC made billing errors to New York and New Jersey Medicaid contractors that resulted in inaccurate servicing provider information on claims for services performed at three of its locations.
The allegations were originally made in a lawsuit filed under the whistleblower provisions of the False Claims Act by Lauren Simpson. The Act permits private parties to sue for false claims on behalf of the United States and to share in any recovery. Simpson will receive a total of $135,622 from the federal and state shares of the settlement.
Former Kentucky Lawmaker Sentenced to Prison in Fraud Case
Robert Goforth a Former Kentucky lawmaker was sentenced October 3, 2022 to two years and one month in federal prison for health care fraud and money laundering.
Goforth, who resigned from the Kentucky House in 2021, also faces two years of supervised release.
Goforth ran unsuccessfully for the Republican nomination for governor in 2019. Goforth pleaded guilty in May 2022, admitting that a pharmacy he owned in Clay County billed insurance programs, including Medicare and Medicaid, for prescriptions that customers didn’t pick up, according to court records. The pharmacy multiplied profits by buying a dose of medicine once and then “effectively selling it multiple times,” according to Goforth’s plea agreement.
Goforth will have to pay $2.7 million in restitution for the fraud and $10,000 in fines. As of Monday, he had paid more than $1 million in restitution, according to court testimony.
U.S. District Judge Robert Wier imposed the sentence at a federal courthouse in Laurel County. Wier said the sentence should serve as a deterrent to others in the health care system who attempt to abuse the trust of others.
In a tearful statement, Goforth told Wier that he was ashamed of what he had done and apologized to his victims and his family.
NYC Doctor Pleads Guilty In $31M Insurance Fraud Plot; Performed Unneeded Surgery
Dr. Sady Ribeiro, 72, is looking at a maximum five-year prison sentence on charges of mail fraud and conspiracy to commit wire fraud, said the Manhattan U.S. Attorney’s office. Ribeiro, a New York City doctor who performed unnecessary surgeries on desperately poor patients as part of a $31 million scheme to scam insurance and lawsuit money pleaded guilty to federal fraud charges at the end of September.
Prosecutors say Ribeiro has also agreed to forfeit $513,000 in proceeds from the crime to the government, and to pay $3.98 million in restitution to the victims, who include businesses and insurance companies.
Some of the 400 patients of Ribeiro and other doctors in the scheme were so broke, they asked for food when they showed up for appointments, the feds said in an indictment.
Ribeiro denies federal prosecutors’ claim that the treatments were “surgeries.”
Ribeiro’s patients were referred to him by a group of lawyers and other “scheme participants” who asked the patients to stage or claim to have suffered trip-and-fall accidents. The feds say the scheme operated from 2013 to 2018.
The purported accidents were cited in lawsuits and insurance claims that yielded money for the lawyers, doctors and a firm run by another defendant, Adrian Alexander, that provided money to fund the scheme.
The patients got little in return for undergoing the needless treatment.
Many of the patients were offered personal loans at 100% interest or loans to cover the costs of their medical care at 50% interest — rates so high that the scheme’s operators ended up with nearly all the proceeds from the slip-and-fall lawsuits, said prosecutors.
Alexander, 77, pleaded guilty for his role in the scheme in August and faces up to five years in prison.
Doctor Prescribing Unneeded Drugs Guilty of Insurance Fraud
Dr. Mohammed El-Nachef pleaded guilty to defrauding California’s Medi-Cal system by prescribing unnecessary drugs to more than 1,000 patients in Orange County to one count of insurance fraud and one count of aiding and abetting the unauthorized practice of medicine.
He was ordered to pay $2.3 million in restitution and surrender his medical license.
Prosecutors said that for two years beginning in 2014, El-Nachef prescribed unnecessary HIV medications, anti-psychotics and opioids to patients at clinics in Anaheim and Los Angeles.
The patients were Medi-Cal recipients who were recruited with the promise of cash payments, and the recruiters then illegally sold the drugs, prosecutors said.
El-Nachef was recruited to write the unnecessary prescriptions and was paid in cash.
Over the course of two years, Mohammed El-Nachef, M.D., took part in an illicit drug-prescription operation where he?prescribed medically unnecessary HIV medications, anti-psychotics, and opioids to over a thousand Medi-Cal beneficiaries in the Los Angeles and Orange Counties. The medications he authorized were not kept or used by the beneficiaries, but instead diverted to the illicit market for cash. Today, El-Nachef pled guilty in the Orange County Superior Court to one count of insurance fraud and one count of aiding and abetting the unauthorized practice of medicine. As part of his plea, El-Nachef is required to pay $2.3 million in restitution and surrender his medical license. His sentencing is?set for August 1, 2023.
El-Nachef was recruited by individuals who were involved in illegally selling the medications. These individuals solicited Medi-Cal recipients with the promise of cash payments to pose as patients, and in turn, El-Nachef agreed to prescribe these patients the medically unjustified medications. The selected drugs were among those with the highest street value. The pharmacies billed Medi-Cal for the medications, which would ultimately end up in the hands of the individuals who recruited El-Nachef, who then sold the drugs for cash. For his part, El-Nachef received cash payments for each day he wrote prescriptions.
Other Insurance Fraud Convictions
Onetime Brewery Owner and Financial Advisor Found Guilty of Murdering Client for Life Insurance Benefits
Keith Todd Ashley, 50, was found guilty by federal jurors in the Eastern District of Texas on charges of wire fraud, mail fraud, carrying a firearm in relation to a crime of violence, and bank fraud.
Ashley, a North Texas man was found guilty of several fraud-related felonies in federal court earlier this week. Prosecutors say the frauds were part of a wide-ranging series of crimes that eventually came to include a murder and coverup orchestrated to obtain life insurance benefits.
The long-beleaguered former owner of Nine Band Brewing, a now closed boutique beer manufacturer that used the armadillo, a non-native mammal related to anteaters and sloths that has nevertheless become a major fixture in Texas on its logo. Ashley was indicted in Dallas County for the murder of one of his clients, 62-year-old James “Jim” Seegan, who was also a close friend, in April 2021.
The defendant has yet to stand trial on his capital murder charge.
Ashley’s fraud-related charges were filed several months prior to the murder allegation. In November Federal prosecutors asserted he had used his position as a financial advisor and life insurance agent to bilk investors out of well over $1 million.
While professing to invest at least nine of his clients’ funds in high-yield financial products with tantalizing returns, Ashley was actually just shuffling money from one client to another while also using some of their money to keep his struggling microbrewery in operation, and, according to the U.S. Attorney’s Office for the Eastern District of Texas, to pay his personal bills and to fund a lavish lifestyle.
Seegan, a resident of the Dallas suburb of Carrollton, was found dead in his own home in 2016, holding a gun in his left hand, with a gunshot wound to his head, a typed suicide note next to his body. The deceased man’s wife told police, however, that her husband was right-handed and did not own a gun. The unsigned purported suicide note was also a bit more than odd, with the last sentence reading: “My last friend Keith Ashley will help you with 972-658-6113.”
Those facts were enough for authorities to find the death suspicious. An investigation ensued. Ashley became a suspect after a thorough look into Seegan’s finances, according to law enforcement.
Ashley’s week-long federal trial was held before U.S. District Judge Amos L. Mazzant in Sherman, Texas, home to Austin College. In sum, he was found guilty of 17 federal offenses and now faces life in prison.
New Books:
“How to Acquire, Understand, and Make a Successful Claim on a Commercial Property Insurance Policy: Information Needed for Individuals and Insurance Pros to Deal With Commercial Property Insurance”
The New Book is now available as a Kindle book here , paperback here and as a hardcover here
Commercial Property Insurance is a necessity for any person or entity owning a piece of commercial property whether it is small or large, whether it is an office building or a warehouse or a factory.
A property owner – unless exceptionally wealthy – cannot afford the risk of losing that property, what it earns from tenants paying rent or from the product produced at the property.
Commercial property insurance is a specialized form of insurance designed to protect the owner or lessee of the property from loss due to perils like fire, lightning, windstorm, hail, earthquake, flood, tornado or other risks of loss.
Most commercial property insurance policies are written on a “direct risk of physical loss” or “all risk of physical loss” basis subject to exclusions that are directly related to the risks faced by the property or some standard exclusions.
This book explains the coverages provided by a commercial property insurance policy, how to acquire a policy of commercial property insurance, what the policy of commercial property insurance insures, how to present a claim, and how to successfully present a claim and collect the funds needed to repair or replace the structure and indemnify the insured against the losses incurred because of the interruption of the business of the insured.
The Compact Book on Ethics for The Insurance Professional
How Ethical Doctrines from the Beginning of the Written Word to the Present Resulted in the Incorporation of the Covenant of Good Faith
Every Person Involved in the Business of Insurance Must Act Ethically in the Business of Insurance
See the full video at https://rumble.com/v1n4avu-the-compact-book-on-ethics-for-the-insurance-professional.html ?and at https://youtu.be/LB6g6O7c0hA
Insurance is, by definition, a business of the utmost good faith. This means that both parties to the contract of insurance must act fairly and in good faith to each other and do nothing that will deprive the other of the benefits the contract of insurance promised.
Without the covenant of good faith and fair dealing, and ethical people who work in the insurance industry applying and fulfilling the covenant, effective insurance to spread the risk of loss to a large community of insurance professionals, is impossible. One cannot act fairly and in good faith without being a person with a well-formed ethical compass.
In 1776, Lord Mansfield acting as an appellate judge serving in the House of Lords of Britain (the predecessor of the United Kingdom) for the first time referred to the covenant of good faith and fair dealing. In the case designated: Carter v. Boehm S.C. 1 Bl. Burr 1906, 11th May 1766. 593, 3 Lord Mansfield in the British House of Lords stated the rule of uberrimae fide (Latin for utmost good faith).
The Tort of Bad Faith
What Every Insurance Professional, Every Insurance Coverage Lawyer, Every Plaintiffs Bad Faith Lawyer, and Every Insurance Claims Person Must know About the Tort of Bad Faith?
The implied covenant of good faith and fair dealing is a concept of insurance law at least three centuries old. It first appeared in British jurisprudence in a case decided by Lord Mansfield sitting in the House of Lords as the highest court in Britain. In Carter v. Boehm. 3Burrow, 1905, Lord Mansfield explained that insurance is a contract upon speculation; the special facts upon which the contingent chance is to be computed, lie, most commonly, in the knowledge of the insured only. The underwriter trusts to his representation, and proceeds upon confidence that he does not keep back any circumstance in his knowledge, to mislead the underwriter into a belief that the circumstance does not exist, and to induce him to estimate the risk as if it did not exist. The keeping back such circumstance is a fraud, and therefore the policy is void.
Lord Mansfield stated the rule still followed to this day: “Good faith forbids either party by concealing what he privately knows, to draw the other into a bargain, from his ignorance of that fact, and his believing the contrary.
The implied covenant explains that no party to a contract of insurance should do anything to deprive the other of the benefits of the contract.”
For insurance to work; for each insurer to properly evaluate the risks presented; for each insurer to obtain the insurance desired; and for each insured and insurer resolve all claims fairly and equitably they must treat each other with the utmost good faith and do nothing to deprive the other of the benefits of the contract.
Each party to the contract of insurance is expected to treat the other fairly in the acquisition and performance of the contract. For example, the prospective insured is required to answer all questions about the risk he, she or it are asking the insurer to take and about the person the insurer is asked to insure. Similarly, the insurer must honestly, clearly and in good faith explain to the insured(s) the risks the insurer is willing to take and the terms, conditions and provisions of the contract of insurance.
Insurance Fraudsters Deserve No Quarter
New Book That Explains How to Defeat or Deter Insurance Fraud
What every insurer should know about how it can be proactive in the efforts against insurance fraud by refusing to pay every fraudulent claim.
How Giving No Quarter Worked
Many years ago, a client I represented was offended that an insured tried to defraud him and the people who were names in the syndicate he represented at Lloyd’s, London.?I walked the Underwriter through the debris of the house that was burned, showed him some of the remains of the allegedly highly valuable fine arts, and then explained how he was deceived into issuing the policy. I was the attorney for Lloyd’s underwriters for the fine arts and Imperial Casualty for the homeowners policy.
The Equitable Remedy of Rescission of Insurance
Rescission is an equitable remedy first created in the ecclesiastical courts of Elizabethan England.
When the United States was conceived in 1776 the founders were concerned with protecting their rights under British common law.?
Common Law is a form of law developed by judges through tribunals and decisions of courts rather than executive branch action and legislative statutes.
Following the common law tradition, legal principles were referred to courts of equity to “mitigate the rigor” of the common law.
Available as: A Kindle book A Paperback or a hardcover .
?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 https://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] ; https://www.zalma.com ; https://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
Really insightful thread! Reflecting on the events of March 15, 2023, highlighted in Zalma's Insurance Fraud Letter ??, it's fascinating to see the evolution in behavioral health practices within insurance claims. A true testament to adaptability! #insurancebooks
Insurance claims expert, consultant at Barry Zalma, Inc. and author/Publisher at ClaimSchool, Inc.
2 年November 15 issue out tomorrow.