ZALMA’S INSURANCE FRAUD LETTER November 1, 2020

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 Quote of the Issue: “Better a good enemy than a bad friend.” -- Jewish proverb 

Please Vote

On or Before November 3, 2020 It is Imperative That Everyone Votes. I Have My Preferences and I Will Exercise the Right and Obligation to Vote. I Hope You All Will Do the Same.

It is the obligation of every citizen of the U.S. are obligated to vote. The election is coming soon and every one of us who are citizens have no reason to fail to vote.

The quality of government significantly affects every person in society. Elections offer us a relatively easy way to improve society if we vote and end up choosing decent governments.

Voting is a citizen’s right to choose who they support and believe should be in power. A right of the American people, voting is a way of making a statement through a simple decision to support a certain candidate. Fairness is intended to be the main aspect of the turnout as the majority wins.

Multiple Acts of Insurance Fraud Must be Distinct

In State of New Jersey v. Randi Fleischman, 917 A.2d 722, 189 N.J. 539, Supreme Court of New Jersey (Decided March 19, 2007, Corrected March 26, 2007, 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.

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.

FACTS

On December 4, 2003, after having made arrangements for a friend to dispose of her 2000 Chrysler Sebring, defendant contacted the Edison Police to report that her car had been stolen. She told the police that she arrived alone at the Menlo Park Mall at 5:30 p.m. on December 4, 2003, and subsequently discovered that her car had been stolen when she returned to the parking lot at 6:15 p.m.

Defendant also telephoned her automobile insurer, Liberty Mutual Insurance Company (Liberty Mutual), to report that her car had been stolen. In that conversation, Fleischman stated that she and a friend arrived at the mall at 9:00 a.m. on December 4 and discovered at 6:30 p.m. that the car had been stolen. In response to questioning about the claim, she told her insurer that she still possessed the automobile’s keys and that she had not been trying to sell her car.

On December 12, 2003, defendant filed with Liberty Mutual an Automobile Theft Affidavit, in which she swore that the automobile had been stolen from the Menlo Park Mall parking lot, that she did not know the thief’s identity, and that she had no information about the car’s whereabouts. Fleischman’s affidavit also stated that she did not own any other automobile and that her car had not been for sale.

Fleischman subsequently admitted that her car had not been stolen and withdrew her insurance claim. A Middlesex County Grand Jury indicted defendant, charging her with second-degree insurance fraud; third-degree attempted theft by deception; third-degree tampering with public records; and fourth-degree false swearing. Five acts of insurance fraud specifically were alleged to support the second-degree insurance fraud charge: (1) defendant’s oral report to Liberty Mutual that her car was stolen; (2) her false affidavit submitted to Liberty Mutual in support of her claim; (3) her statement to the Edison Police that she arrived alone at the mall at 5:30 p.m. on December 4; (4) her contradictory statement that she arrived at the mall with a friend at 9:00 a.m. on December 4; and (5) her statements to Liberty Mutual that she did not own any other vehicles and that her Sebring was not for sale.

On leave to appeal granted to the State, the Appellate Division affirmed Count One’s dismissal, holding that each lie told in support of one fraudulent claim in a single document cannot reasonably be seen as a separate act of insurance fraud, but rather only as a component of the one fraudulent claim.

ANALYSIS

In 1983, the Legislature passed the Insurance Fraud Prevention Act (IFPA), N.J.S.A. 17:33A-1 to -14, codifying the State’s intent “to confront aggressively the problem of insurance fraud.” The IFPA imposed stiff civil monetary penalties against perpetrators of insurance fraud. In 2003, the Legislature added the crime of insurance fraud to the Code as part of a comprehensive set of solutions to the automobile insurance availability and affordability challenges facing insurers, consumers and regulators in New Jersey.

Pursuant to N.J.S.A. 2C:21-4.6(a), a person commits “insurance fraud” when one knowingly makes, or causes to be made, a false, fictitious, fraudulent, or misleading “statement” of material fact in any record, bill, claim or other document, in writing, electronically, orally or in any other form, that a person attempts to submit, submits, causes to be submitted, or attempts to cause to be submitted as part of, in support of or opposition to or in connection with: a claim for payment, reimbursement or other benefit pursuant to an insurance policy. The offense is elevated from the third to the second degree when a person commits five or more acts of insurance fraud and the aggregate value of “property, services or other benefits obtained or sought” exceeds $1,000. N.J.S.A. 2C:21-4.6(b). The statute further provides: “Each act of insurance fraud shall constitute an additional, separate and distinct offense, except that five or more separate acts may be aggregated for the purpose of establishing liability pursuant to this subsection. Multiple acts of insurance fraud which are contained in a single record, bill, claim, application, payment, affidavit, certification or other document shall each constitute an additional, separate and distinct offense for purposes of this subsection.”

Thus, the breadth of the phrase “act of insurance fraud” for grading purposes depends, in part, on the breadth of the term “statement,” in subsection a. of the Act.

Because each “statement of material fact” would constitute an “act” and multiple acts in a single document may be separate offenses, the State asserted that the Legislature intended prosecutors to dissect documents for “statements” of fraud. Before this Court, the State took the position that it presented to the grand jury evidence of nine specific fraudulent “statements,” constituting nine acts of insurance fraud by defendant. Defendant conceded that multiple documents or statements submitted in support of a fraudulent claim may be separate fraudulent “acts” and, further, that multiple acts of fraud may be contained in a single document. 

In the criminal context, a “statement” has a variety of meanings. In criminal procedure, “statement” is commonly understood to refer to a narrative and not a single declaration, such as, for example, a criminal suspect’s statement to police.

The State urges that we consider the Legislature’s strongly expressed desire to curb the rampant and expensive problem of insurance fraud by increasing the penalties for such behavior. When interpreting criminal statutes, whatever be the rule of construction, it is subordinate to the goal of effectuating the legislative plan as it may be gathered from the enactment when read in the full light of its history, purpose and context. The premise of the State’s argument is that a narrow reading of “statement” would permit the finding of more “acts” of insurance fraud and, therefore, would allow the imposition of harsher punishment on individuals who submit false statements in connection with an insurance claim.

IFPA, the predecessor to the instant criminal provision, addressed insurance fraud through the imposition of stiff civil penalties. Although civil in nature, IFPA punished the submission of a false or misleading “statement” through language essentially identical to that which now appears in the criminal statute.

Each knowing and material false statement enhances a fraudulent claim, making the danger of payment more likely. Insurers often require a claimant to file several documents as supporting proof of a claim for benefits. Claimants frequently must present a “proof of loss” in the form of a detailed factual statement or statements to justify claims for benefits. Each additional statement further supports the credibility of the claim. Therefore, a claimant who makes a fraudulent claim in an initial documentation may well have subsequent opportunities to rectify previous misrepresentations when the insurer calls for further proof of loss. The person who persists in asserting a fraudulent claim by continuing to submit material misrepresentations compounds the evil that the legislature seeks to eliminate with the IFPA. Construction of the IFPA to penalize claims rather than component statements would produce the inequitable result of placing the State in the same position with respect to the defendant as it would be in with respect to a claimant who makes an initial false statement and then recants. Such a result fails to effectuate the legislature’s intent that persons who file several false statements should be punished for each instance of prohibited conduct.

It would be unreasonable to increase the penalty for each instance that the same misrepresentation appears in a single document or for false assertions that substantively repeat information contained in other misrepresentations in the same document.

When a defendant provides to officials in connection with a fraudulent claim a document or oral narrative that contains a material fact or facts relating to the claim, each such document or narration is a “statement” equating to an “act” of insurance fraud. Although we recognize that there can be multiple “statements” in a single document or narration, for example when a document’s or narration’s contents relate to a separate claim of loss (the fur coat example), the court rejected the assertion that the Legislature intended every discrete fact within a narrative assertion about a single claim would amount to an “act” of insurance fraud. Because defendant’s oral and written statements related to a single claim of a stolen automobile, the State presented three “acts” of insurance fraud to the grand jury: defendant’s report to the police, defendant’s oral report of the alleged theft to Liberty Mutual, and defendant’s affidavit submitted to Liberty Mutual in support of her claim.

The judgment of the Appellate Division is affirmed for the reasons expressed in this opinion.

OIG Most Wanted Fugitives

The Office of the Inspector General has created a webpage contains information about OIG’s most wanted health care fugitives. In all, they are seeking more than 170 fugitives on charges related to health care fraud and abuse. All the fugitives are available at https://oig.hhs.gov/fraud/fugitives/profiles.asp#thorsen. Some of those wanted include:

Poul Thorsen

From approximately February 2004 until February 2010, Poul Thorsen executed a scheme to steal grant money awarded by the Centers for Disease Control and Prevention (CDC). CDC had awarded grant money to Denmark for research involving infant disabilities, autism, genetic disorders, and fetal alcohol syndrome. CDC awarded the grant to fund studies of the relationship between autism and the exposure to vaccines, the relationship between cerebral palsy and infection during pregnancy, and the relationship between developmental outcomes and fetal alcohol exposure.

Thorsen worked as a visiting scientist at CDC, Division of Birth Defects and Developmental Disabilities, before the grant was awarded.

The initial grant was awarded to the Danish Medical Research Council. In approximately 2007, a second grant was awarded to the Danish Agency for Science, Technology, and Innovation. Both agencies are governmental agencies in Denmark. The research was done by the Aarhaus University and Odense University Hospital in Denmark.

Thorsen allegedly diverted over $1 million of the CDC grant money to his own personal bank account. Thorsen submitted fraudulent invoices on CDC letterhead to medical facilities assisting in the research for reimbursement of work allegedly covered by the grants. The invoices were addressed to Aarhaus University and Sahlgrenska University Hospital. The fact that the invoices were on CDC letterhead made it appear that CDC was requesting the money from Aarhaus University and Sahlgrenska University Hospital although the bank account listed on the invoices belonged to Thorsen

In April 2011, Thorsen was indicted on 22 counts of Wire Fraud and Money Laundering.

According to bank account records, Thorsen purchased a home in Atlanta, a Harley Davidson motorcycle, an Audi automobile, and a Honda SUV with funds that he received from the CDC grants.

Thorsen is currently in Denmark and is awaiting extradition to the United States.

Abubakar Durrani

In October 2013, Abubakar Durrani was indicted on charges of healthcare fraud, false statements related to healthcare matters, mail fraud, and illegal drug distribution. Investigators believe that Durrani, an orthopedic spine surgeon, billed Medicare, Medicaid, and private insurance companies millions for spinal surgeries and related services that were not medically necessary and were potentially harmful to patients.

Durrani owned the Center for Advanced Spine Technologies (CAST), which had offices in Ohio and Kentucky. According to the indictment, Durrani falsely diagnosed Medicare patients with spinal-related medical conditions and then persuaded the patients to undergo surgery, even though the patients did not need surgery. Durrani often told patients that the medical situation was urgent and that surgery was needed right away or they would be at risk of suffering from grave injuries. For cervical spine patients, Durrani often told patients that there was a risk of paralysis or the head would fall off if the patient was in a car accident because there was almost nothing attaching the head to the patient’s body.

Durrani either ignored or never read patient radiology reports; rather he provided his own reading, which was either inconsistent with or contrary to the reports written by the radiologists. Durrani also ordered pain injections that were inconsistent with either the pain stated by the patient or from the imaging reports.

Durrani dictated his operative reports and other patient records months after the actual treatments. These reports and records contained false statements about the diagnoses of the patients, the procedures performed, and the instrumentations used in the procedures. In addition, Durrani failed to inform his patients of complications experienced during the surgeries.

According to the indictment, many patients treated by Durrani for back and neck pain were left in worse shape because of the unnecessary surgeries he performed.

Investigators believe that Durrani fled the United States while awaiting trial after the court denied his request for permission to travel outside the country. He may be residing in Pakistan.

Ji Hae Kim

In November 2011, Ji Hae Kim was charged for conspiracy to commit healthcare fraud. According to the criminal information, Ji Hae Kim (Kim), a registered nurse, worked for Greatcare Home Health, Inc. (Greatcare), a home health agency located in the Los Angeles area. Kim pleaded guilty in November 2011; she was released and was waiting to be sentenced when she fled.

Medicare paid Greatcare approximately $5.1 million for home health services that were purportedly provided.

According to the criminal information, Kim prepared false forms for Medicare patients receiving home health services from Greatcare, making it appear as though the patients’ medical conditions and lack of willing caregivers made them eligible for home health services. Kim also falsified daily route sheets and skilled nursing notes to make it appear as though she had visited patients whom she had never visited.

Jahaziel Garcia Gonzalez

Kim fled the United States while waiting for sentencing. She is a fugitive at large and maybe residing in South Korea.

On July 7, 2009, Jahaziel Garcia Gonzalez was indicted on charges of healthcare fraud and forfeiture. Investigators believe that through his company, Gonzalez submitted nearly $2.4 million in false claims to Medicare for durable medical equipment (DME) items and services that were not prescribed by doctors or provided as claimed.

Gonzalez controlled and operated A & L Professional, Inc., a DME company based in Miami, Florida. According to the indictment, from around October 2008 to around March 2009, Gonzalez allegedly submitted or caused the submission of numerous false claims to Medicare on behalf of A & L Professional for powered air mattresses, non-disposable pump canisters, and other DME that was not prescribed by doctors or provided as claimed.

Medicare reimbursed A & L Professional nearly $1 million for these false claims. Gonzalez allegedly transferred these funds from A & L Professional’s corporate bank account to himself and others.

An arrest warrant for Gonzalez was issued in July 2009, but he could not be located. Gonzalez remains at large.

Patricia Mubanga Chisanga

On November 7, 2012, Patricia Mubanga Chisanga was indicted on charges of healthcare fraud and conspiracy to commit healthcare fraud. Previously, Chisanga’s co-conspirator Uche Ben Odunzeh pleaded guilty one count of conspiracy to commit healthcare fraud and was sentenced to 19 months in prison.

Emerald Medical Services (Emerald) is a durable medical equipment company operating in the District of Columbia and purportedly providing wheelchairs and other medical equipment to Medicaid patients.

Chisanga is listed as the Vice President of Operations on the business records for Emerald.

Investigators believe that authorization forms necessary for the submission of claims to Medicaid were altered after they were signed by the prescribing physician. These forms were allegedly used by Emerald to bill Medicaid for more expensive equipment than was actually provided to the patients.

Emerald would provide patients with a lower level power wheelchair when, in fact, a higher level wheelchair was authorized.

From approximately January 2008 through March 2011, Emerald collected $480,000 from Medicaid for durable medical equipment that was never provided.

OIG Special Agents confronted Chisanga about her participation in the scheme. After this confrontation, she fled the United States to Ethiopia, then took a flight to her native Zambia.

Chisanga remains at large.

Wisdom

“The present Constitution is the standard to which we are to cling. Under its banners, bona fide must we combat our political foes.” — Alexander Hamilton

“The liberties of a people never were, nor ever will be, secure, when the transactions of their rulers may be concealed from them.” —Patrick Henry

“Facts do not cease to exist because they are ignored.” – Aldous Huxley

“Socialists desire to practice legal plunder, not illegal plunder. Socialists, like all other monopolists, desire to make the law their own weapon. And when once the law is on the side of socialism, how can it be used against socialism? For when plunder is abetted by the law, it does not fear your courts, your gendarmes, and your prisons. Rather, it may call upon them for help.” —Frederic Bastiat

“Some men are born mediocre, some men achieve mediocrity, and some men have mediocrity thrust upon them.” – Joseph Heller

“It pays to be obvious, especially if you have a reputation for subtlety.” — Isaac Asimov

“Truth does not become more true if the whole world were to accept it; nor does it become less true if the whole world were to reject it.” — Maimonides

“An election is nothing more than the advanced auction of stolen goods.” —Ambrose Bierce

“The purpose of life is not to be happy. It is to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well.” — Ralph Waldo Emerson

“To live is the rarest thing in the world. Most people exist, that is all.” – Oscar Wilde

“It is not the business of government to make men virtuous or religious, or to preserve the fool from the consequences of his own folly. Government should be repressive no further than is necessary to secure liberty by protecting the equal rights of each from aggression on the part of others, and the moment governmental prohibitions extend beyond this line they are in danger of defeating the very ends they are intended to serve.” —Henry George

“Whenever you are asked if you can do a job, tell ‘em, ‘Certainly I can!’ Then get busy and find out how to do it.” -- Theodore Roosevelt

“Nemo debet esse judex in propria causa (i.e. ‘no one should be made a judge in his own cause’)” – Ancient Law

“The world you desire can be won, it exists, it is real, it is possible, it is yours.” – Ayn Rand

“There is in human nature a resentment of injury, and indignation against wrong, a love of truth and a veneration of virtue ... if the people are capable of understanding, seeing and feeling the differences between true and false, right and wrong, virtue and vice...” —John Adams

Proof of Confession That Accident Was Staged Requires Summary Judgment

In Global Liberty Insurance Company v. Gabriel Laruenceau, et al., Longevity Medical Supply, Inc., et al., 2020 NY Slip Op 05851, Index No. 300062/15, Appeal No. 12111, Case No. 2019-04968, Appellate Division of the Supreme Court of the State of New York (October 20, 2020) the trial court, the Supreme Court, Bronx County (Wilma Guzman, J.), denied plaintiff’s motion to renew its motion for summary judgment declaring in its favor against defendants Longevity Medical Supply, Inc., Jamaica Wellness Medical, P.C., United Wellness Chiropractic, P.C., and Lvov Acupuncture, P.C. The appeal asked the Appellate Division to allow the defense.

FACTS

Plaintiff provided a policy of insurance to VIP Limousine & Tuxedo, Inc. (VIP) that included a no-fault endorsement to an insured or eligible person for necessary expenses resulting from a motor vehicle accident. In April 2014, one of VIP’s limousines was hit in the rear by another car. Thereafter, the driver and passengers of the limousine (the individual defendants) filed claims as eligible persons under the policy issued by plaintiff, and later assigned their rights to the no-fault benefits to various medical providers (medical provider defendants).

Plaintiff moved for summary judgment, asserting that the accident was staged and therefore, none of the individual defendants or the medical provider defendants were entitled to benefits under the policy. The Supreme Court denied the motion, finding that plaintiff failed to demonstrate as a matter of law that the accident was fraudulently or intentionally procured.

Plaintiff moved to renew its prior motion for summary judgment. In support of its motion to renew, plaintiff submitted additional evidence that the accident was staged in the form of a videotape confession by one of the passengers, which it had procured, after extensive motion practice, from the Police Department, Department of Financial Services, Insurance Fraud Bureau (DFS), and Kings County District Attorney’s Office. The renewal was denied on the grounds that plaintiff failed to offer any reasonable explanation as to why the videotape could not have been attached to its prior motion, and that the videotape was not properly authenticated for purposes of summary judgment.

THE APPEAL

Although it is true that a motion to renew should generally be based upon newly-discovered facts, this rule is not inflexible, and the court has discretion to grant renewal in the interest of justice even upon facts that were known to the movant at the time the original motion was made. Plaintiff demonstrated that the additional evidence it submitted in support of its motion to renew would change the prior determination and that it was required to engage in extensive motion practice to obtain the material. Plaintiff also established that it was unaware of the nature and extent of the information held by those agencies before then. The material, which included statements by the passengers who assigned their claims to defendants, proves that the motor vehicle accident was staged.

Contrary to defendants’ contentions, the videotape of the confession of one of the defendants who participated in the scheme and the statements others provided to the police and DFS are admissible as party admissions. Plaintiff demonstrated the authenticity of this material by proof of the complete chain of custody.

Defendants failed to submit any evidence controverting plaintiff’s proof that the accident was staged.

ZIFL OPINION

This case clearly established that the accident was staged and there was no reason for the trial court to refuse to allow it present the obvious and damning proof. More importantly, this case teaches that although insurers are obligated to cooperate with and provide everything its investigation reveal to the prosecution and the Fraud Division, but the obverse is not true. There is no reason why the prosecutors who obtained a confession from one of the co-conspirators should have forced the insurer to jump through litigation hoops to get the statement and continue defending a fraudulent suit. They should have shared that evidence immediately to assist the victim of the crime.

 Good News From the

Dr. Richard Stehl was handed 15 years in federal prison in Montgomery, Ala. Amanda Bagents said her addiction peaked when she took 1,500 milligrams of the painkiller Tramadol every day. Stehl even confronted Bagents about her doctor shopping but kept prescribing to her. Several patients testified their addictions worsened under Stehl’s prescribing. He prescribed 11 different types of controlled meds to another patient. The patient ODd twice, though Stehl kept prescribing the med he overdosed on. The case against Stehl began when a patient’s family grew concerned the doc was over-prescribing controlled meds, and reported Stehl to the state medical board. Stehl ranked in the top 1% of Alabama docs for prescribing opioids in 2018. Stehl underwent professional evaluation in 2012 after 2 women reported him for “inappropriate sexual advances.” 

An electrician’s $125,000 workers-comp scam was short-circuited. Michael Ray Williams claimed a work injury and started receiving benefits from the State Compensation Insurance Fund, in California. The Daly City man began working for another employer while taking in state workers-comp money. He then claimed another work injury and started receiving comp money from Travelers Insurance. Williams worked for 3 different employers between March 2015 and November 2016. At one point, he collected money from the state comp fund and Travelers for 2 claimed injuries, while continuing to work. Williams lied about his level of injury, abilities, earnings and employment status to the state fund and medical providers. He also lied to the Qualified Medical Examiner to collect permanent disability after exhausting his temporary benefits. And he was charged with using a former employer’s credit card for personal expenses, including an engagement ring. Williams pled guilty and received 60 days in county jail. He’s repaid $40,000 to the state comp fund, and also must repay Travelers and his former employer.

Eugene Gosy will spend 5 years in prison for operating a Western New York pill mill. He pleaded guilty earlier this year to conspiracy to distribute controlled substances and healthcare fraud. Authorities say he was the top controlled substance prescriber in the entire state. Gosy was fast and loose with his prescription pad, handing blank scripts to allow others to fill them out; prescribing opioids without exams; and issuing doses and drug combos that could harm his patients. On top of his controlled substance endeavors, Gosy also signed death certificates without an autopsy or medical exam.

A Miami pill mill operator who distributed 11 million tablets of oxycodone, oxymorphone, and morphine was sentenced to 33 years in prison. Sylvia Hofstetter operated multiple pain clinics in Florida and Tennessee. Hofstetter’s operation began in Hollywood, Fla. where she worked in an illicit clinic for 3 of her co-conspirators. Her team began making plans to move to East Tennessee when law enforcement sweeps began shutting down hundreds of pill mills in South Florida. Hofstetter stepped into the role of operator, once the operation relocated to Knoxville, Tenn. Prosecutors say Hofstetter’s role in Tennessee was to run the pill mills and ensure that patient volume remained high. Once in Tennessee, however, Hofstetter opened her own pill mills in secret from her Florida employers and went into competition against them. Hofstetter personally reaped over $4 million from her role. Hofstetter was convicted of RICO conspiracy, 2 counts of drug conspiracy, money laundering and maintaining drug-involved premises. 

April Rose Ambrosio falsely claimed she performed 800 root canals on 100 patients within a 4 year timeframe. Investigators learned Ambrosio billed for work on days her office was closed or she claimed to be on vacation. Her fraudulent billing practices were brazen. For one family of 4, she billed insurance companies for more than 100 root canals in a 90-day period. Ambrosio even billed for root canals performed on non-existent or missing teeth. She also double billed for teeth she previously claimed to have performed root canals on. Ambrosio’s license to practice dentistry was suspended on Sept. 24, 2019. The California dentist was handed a 6-year sentence for fraudulently billing multiple insurance companies nearly $900,000 to reap more than $400,000 in personal profit.

Rezik Saqer, an anesthesiologist lured vulnerable patients to his Houston-area pill mills by prescribing powerful opioids, then required them to get unneeded and dangerous procedures and tests. It was all part of Saqer’s $5-million scheme. Many procedures were performed by unlicensed staff. Saqer’s con contributed to multiple overdose deaths, and the death of a young family in an auto accident involving a patient. Saqer prescribed 4 bottles of addictive drugs to Ronald Cooper. He took the drugs and then crashed his car while high. He killed Roland Sedlmeier, his wife Melinda and their 2 children. Cooper earlier was sentenced to 80 years in prison. Saqer was handed 5 years in federal prison this week.

Pharmacy owners brewed compound meds based more on profit than medical need in an $18-million con. Dempsey Bryan Levi and Jeffrey Rollins ran Lovelace Drugs, in the Biloxi, Miss. area. They bribed physicians to order and recommend pricey compound creams for patients. Those prescriptions were filled only by Lovelace. That left patients with no choice of which pharmacy to use. Levi and Rollins mixed the creams using ingredients based on how much profit they made, not on the patient’s doctor-defined medical needs. The pharmacy also dispensed cheaper generic drugs, then billed for more-expensive brands. The outfit sent fraudulent bills to Medicare, private insurers and other programs. Levi and Rollins pled federally guilty and will be sentenced later.

Florida’s highest court will have the final word over Scot Strems’ fate after the state bar’s request for emergency suspension of the Coral Gables man for causing “great public harm.” The bar alleged that Strems engaged in “mendacious, bad-faith conduct” and made dishonest statements to others involved in suits, the bar charges Strems also illegally filed multiple lawsuits on an individual policy claim. He then delayed and ignored court deadlines, and violated court orders. Strems filed separate lawsuits against insurers for individual claims, “even though they occur under the same policy, at the same property, and at the same time.” A water mitigation firm then filed multiple lawsuits for the same losses. The mitigation firm proceeded under AOBs executed by SLF’s clients. “The end result is that the involvement of respondent and his firm results in four separate lawsuits filed resulting from the same alleged occurrence,” the bar petition says.

Health Insurance Fraud Convictions

48 Months in Prison for Health Care Fraud

Susanne “Suzi” Gawel was sentenced to 48 months in prison, one year of supervised release and ordered to pay $646,690.32 in restitution after conviction. Gawel worked as an office manager at a Fort Wayne company that sold durable medical equipment (DME) to clients across northern Indiana. Some of the company’s clients were Medicaid beneficiaries. Through her work, Gawel had access to Medicaid patient information, including patients’ names, addresses, dates of birth, Medicaid ID numbers and treating physician information.

From about January 2015 and continuing to about October 2018, Gawel devised a scheme to defraud Medicaid, according to court documents. During this time period, she submitted over 200 reimbursement claims to Indiana Medicaid for DME, including oximetry devices and pneumatic compressors, which were not provided to Medicaid recipients and/or for which they had no medical necessity and/or for which there was no physician order. In total, her scheme defrauded Indiana Medicaid of approximately $646,690.32.

Besides the Office of the Attorney General’s Medicaid Fraud Control Unit, other agencies that worked on this case are the Federal Bureau of Investigation and the U.S. Department of Justice, which prosecuted Gawel.

Preferred Family Healthcare Will Pay $4.5 million Plus Almost $2 Million to Settle Fraud Charges

Preferred Family Healthcare (PFH) entered into a settlement with Arkansas Attorney General Leslie Rutledge on October 22, 2020 that provided multimillion dollar federal and state civil settlements. The settlements were based on an investigation conducted by the Attorney General Office’s Medicaid Fraud Control Unit (MFCU) into false claims submitted to the Arkansas Medicaid Program by former PFH employees. PFH has agreed to pay $4,555,632.10 to resolve a federal false claims case and $1,944,367.90 in a separate state settlement under the State False Claims Act. In addition to the larger settlement, five former employees of PFH have been charged in state court with Medicaid fraud and an additional employee settled false claims or actions.

Through most of 2016, the MFCU investigated fraud in the Rehabilitative Services for Persons with Mental Illness (RSPMI) program. In September 2016, an informant and employee of PFH made a complaint to the MFCU claiming PFH had been billing Medicaid for counseling services not rendered or over-billed. These allegations involved inappropriate billing by individual therapists.

In December 2017, the informant contacted the MFCU with additional information that indicated PFH may have been inappropriately billing an entire class of recipients known as Qualified Medicare Beneficiaries (QMBs). Using data analytics, the MFCU was immediately able to confirm that claims for services improperly provided to this population were being submitted to Medicaid for payment rather than Medicare. While it was clear that the submitted claims were improper, it was not clear who within PFH was submitting the claims, whether they understood what they were doing was illegal, or how the claims were able to get through the edits in place in the Medicaid payment system that should have rejected the claims.

In early January 2018, the MFCU served PFH with a “Request for Information” seeking to determine how this had occurred. Later that same month the state’s informant filed a federal sealed qui tam action against PFH under the federal false claims act. A qui tam action is a federal lawsuit brought by a private citizen to stop or prevent fraud and abuse of federal dollars.

PFH, a large mental health care organization, offered a range of services which included mental and behavioral health, substance use, employment, developmental disabilities, child welfare, and medical. Until October 2018, there were approximately 50 clinics throughout Arkansas. PFH no longer operates in the State of Arkansas.

North Carolina Man Is Sentenced to Prison for Conspiring to Steal Millions from Medicaid

Leader of the Conspiracy Already Sentenced to Eight Years

Jerry Lewis Taylor, 55, of Wingate, N.C., was sentenced to five years in prison followed by two years of supervised release on October 22, 2020 for conspiring to steal millions from Medicaid and committing tax evasion. In addition to the prison term imposed, Jerry Taylor was also ordered to pay more than $6.1 to North Carolina Medicaid and over $346,000 to the U.S. Internal Revenue Service as restitution.

On Tuesday, October 20, 2020, Jerry Taylor’s co-conspirator, Ameera Ali, 41, of Columbus, Ohio, was sentenced to 84 months in prison and one year of supervised release, for her role in the scheme. In July 2020, the leader of the scheme, Tony Garrett Taylor, 40, of Brooklyn, N.Y., was sentenced to 96 months in prison and two years of supervised release.

According to filed court documents and the October 22 sentencing hearing, from June 2015 to December 2017, Jerry Taylor and his brother, Tony Taylor, orchestrated a scheme to defraud Medicaid of more than $9.4 million by submitting false and fraudulent reimbursement claims for patient services that were either non-existent or mischaracterized to Medicaid. The brothers submitted the fraudulent claims through several companies they owned and/or operated, including Taylor Behavioral Health Center, LLC and Options Driven LLC, both located in Monroe, N.C.; Design for Change LLC located in Raleigh and elsewhere; and SHG Consultants, located in Gastonia, N.C. and elsewhere (collectively, the “the entities”). These entities specialized in providing outpatient behavioral health services to at-risk youth throughout North Carolina.

Court records show that, during the relevant time period, Jerry Taylor was responsible for overseeing certain aspects of the business operations of the entities, including managing the preparation and submission of fraudulent claims through the entities’ third-party billing company owned by Ameera Ali. According to court records, in addition to providing billing services for the conspiracy, Ameera Ali furnished Tony Taylor with prospective patient lists containing identifying information for eligible Medicaid beneficiaries. The beneficiary information obtained from Ali and others were used, in turn, to file fraudulent reimbursement claims for services that were never provided. To the extent that services were actually provided, the conspirators submitted to Medicaid fraudulent reimbursement claims that misrepresented the services rendered so as to obtain a higher reimbursement rate, a practice known as “upcoding.”

According to court documents, Tony Taylor also recruited Devon Rambert-Hairston, a licensed nurse practitioner and the director of one of the entities operated by the brothers, to review and sign-off on fictitious patient progress notes. Court records show that Rambert-Hairston never provided any behavioral health or medical services to the Medicaid beneficiaries or rarely interacted with them at all. To the extent that the beneficiaries received any treatment, those services were provided by an individual identified in court documents as J.B., who was not credentialed to provide those types of services.

Jerry Taylor and Tony Taylor also conspired with Christine Yvette Knight, who operated Connect and Move Staffing LLC in Florida. Knight’s role in the conspiracy was to create fraudulent treatment notes for the beneficiaries, and to prepare fake billing spreadsheets which were used by the brothers to further perpetuate the fraud.

During the course of the fraudulent scheme, Jerry and Tony Taylor caused hundreds of false and fraudulent claims to be submitted to Medicaid for false and fraudulent services. As a result, more than $9.4 million in fraudulent claims were submitted to Medicaid, resulting in approximately $6.1 million in fraudulent payments from Medicaid.

In addition to health care fraud, Jerry Taylor also committed tax evasion, by failing to file timely and/or accurate U.S. Individual Income Tax Returns for tax years 2016 and 2017, and failing to report more than $1.6 million in fraudulent receipts from Medicaid that were diverted to nominee entities and individuals. Jerry Taylor used the fraudulent proceeds for personal expenditure using business accounts, including to pay for medical expenses, personal travel, and to make large cash withdrawals, among other things.

Healthcare Fraud Settlement for Over $1.2 Million

Great Lakes Medical Laboratory, Inc. (Great Lakes) has settled health care fraud charges. Pursuant to the Settlement Agreement, Great Lakes Will Pay $1,200,737.64 to resolve allegations that the Michigan laboratory engaged in a billing scheme that defrauded Medicare and the United Mine Workers of America 1992 Benefit Plan,

Great Lakes operated a medical reference laboratory in Michigan and routinely tested urine and blood samples referred by medical providers located in West Virginia and elsewhere. From in or about January 4, 2016 continuing into or about May 12, 2017, great lakes presented at least 21,732 claims to Medicare And the UMWA Funds which included separate claims for reimbursement for services which were already included in bills submitted for other laboratory services. Moreover, investigators learned that the fraudulent claims were for services that were not specifically ordered by the referring physicians, and determined that there was no indication that the services billed were actually performed. These false claims resulted in a loss to Medicare and the UMWA funds in the amount of $600,368.82. As a result of the $1,200,737.64 settlement, which represents twice the actual loss suffered by Medicare and the UMWA funds, both federal programs will be made whole.

New York City Pharmacy Owner Sentenced To 2? Years in Prison

Sajid Javed, an owner and operator of a number of pharmacies in the New York City area, was sentenced to 30 months in prison for using his pharmacies to submit more than $7.1 million in fraudulent claims to Medicare and Medicaid. JAVED previously pled guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Vernon S. Broderick, who imposed today’s sentence.

According to the Complaint, the Superseding Information to which JAVED pled guilty, court filings, and statements made in public court proceedings: “While owning and operating a number of pharmacies located in Brooklyn and Queens, JAVED conducted a multimillion-dollar scheme to defraud Medicare and Medicaid programs by seeking reimbursement for prescription drugs that were not distributed to customers. Specifically, from January 2013 through December 2014, JAVED obtained more than $7.1 million in reimbursements from Medicare and Medicaid for prescription drugs that his pharmacies never actually dispensed to customers. JAVED defrauded Medicare and Medicaid into providing him with these reimbursements by obtaining prescriptions from other individuals, who were willing to forego delivery of the medications in exchange for a share of the reimbursed proceeds, in the form of kickbacks. JAVED offered to pay, and did actually pay, kickbacks in furtherance of this scheme.

In addition to the prison term, Judge Broderick sentenced JAVED, 49, of Fresh Meadows, Queens, to three years of supervised release and ordered JAVED to make court-ordered restitution in the amount of $6,040,451.32 to Medicare and $1,150,562.16 to Medicaid, and imposed forfeiture in the amount of $7,191,013.48.

Pharmacist Sentenced for Presenting Forged Prescriptions Opioid and Anti-Malaria Prescription Drugs

Tamara Jo Nyachira, of Pittsburg, Kansas, was sentenced October 27, 2020 to three years’ probation, a $5,000 fine and 100 hours of community service after pleading guilty to obtaining narcotic opioid prescription drugs with forged prescriptions before Chief United States District Judge Rodney W. Sippel.

According to her plea agreement, Nyachira was a pharmacist for a large pharmacy chain, and worked at various pharmacies throughout Missouri, including one in Farmington, Missouri. Nyachira admitted that she used a forged prescription to fraudulently obtain Codeine/butalbital/acetaminophen/caffeine (sometimes marketed as Fioricet? with Codeine), which is an opioid drug and Schedule III controlled substance.

Further, Nyachira admitted in her plea agreement that during March of 2020, Nyachira used several forged prescriptions to obtain two drugs, amoxicillin clavulanate potassium (sometimes marketed as Augmentin?) and hydroxychloroquine sulfate (sometime marketed as Plaquenil?). In her plea agreement, defendant admitted that she wanted to stockpile these drugs for herself and her family, and use them later if she or her family were directly exposed to or infected by the COVID-19 virus. Defendant admitted that her conduct was wrongful in that it helped create shortages of these drugs, which are often used by elderly or low-income patients with chronic conditions such as lupus or arthritis.

Suboxone Manufacturer Indivior’s Former Chief Executive Officer Sentenced to Six Months in Prison

Shaun Thaxter, the former chief executive officer of Indivior PLC, was sentenced October 22, 2020 in U.S. District Court in Abingdon to 6 months in federal prison. He was also ordered to pay a fine of $100,000 and forfeit $500,000. Thaxter pleaded guilty to a one-count misdemeanor information on June 30, 2020 for his role in causing the introduction into interstate commerce of misbranded shipments of the opioid drug Suboxone Film, a violation of the Federal Food, Drug, and Cosmetic Act.

Thaxter served as Indivior’s top executive from 2009 until shortly before his guilty plea. This includes the time period prior to December 2014 when Indivior was known as Reckitt Benckiser Pharmaceuticals. When Indivior was known as Reckitt Benckiser Pharmaceuticals, it was a subsidiary of British conglomerate Reckitt Benckiser Group (RB Group). RB Group paid $1.4 billion in 2019 to resolve its liability to the United States related to the marketing of Suboxone. On July 24, 2020, an Indivior subsidiary called Indivior Solutions pleaded guilty to a one-count felony information for false statements related to health care matters, and together with Indivior, agreed to pay an additional $600 million to resolve liability to the United States related to the marketing of Suboxone. On August 26, 2020, Indivior’s former medical director, Timothy Baxter, pleaded guilty to a one-count misdemeanor information for a violation of the Federal Food, Drug, and Cosmetic Act related to the marketing of Suboxone. Indivior Solutions and Baxter have not yet been sentenced.

Suboxone Film is a drug product approved for use by recovering opioid addicts to avoid or reduce withdrawal symptoms while they undergo treatment. Suboxone’s active ingredient, buprenorphine, is a powerful and addictive opioid. Thaxter was charged in connection with Indivior’s misrepresentations regarding the safety of Suboxone Film.

The Prosecutors noted that misrepresentations made about the drug, while Thaxter ran the company, misled MassHealth about the potential risk of accidental opioid exposure. It is inexcusable to willfully disregard requirements that treatment medications be prescribed carefully in order to protect patient health and safety.

According to court documents, Thaxter had authority over Indivior’s marketing and sales of Suboxone Film which, along with other Suboxone products, generated nearly all the company’s revenue. In 2012, Thaxter oversaw and encouraged Indivior’s efforts to secure formulary coverage for Suboxone Film from the Massachusetts Medicaid agency called MassHealth. Thaxter asked Indivior employees under his direction to devise a strategy to win preferred drug status for Suboxone Film and counteract a non-opioid competitor MassHealth was considering for opioid-addiction treatment. Certain Indivior employees subsequently shared false and misleading safety information with MassHealth officials about Suboxone Film’s risk of accidental pediatric exposure. Two months after receiving that false and misleading information, MassHealth announced it would provide access to Suboxone Film for Medicaid patients with children under the age of six.

ZIFL can only wonder why the punishment was so minimal. Six months in prison for putting out a deadly chemical on false pretenses.

Ringleader in Insurance Fraud Operation Sentenced to 10 Years (Suspended) and 90 Days

Renara Jessica Burgess entered a guilty plea October 15, 2020 to two counts of presenting a false claim for payment greater than $10,000. Burgess, a Florence, South Carolina woman pleaded guilty after serving as the ringleader of an insurance fraud operation that saw hundreds of thousands of dollars in fraudulent claims being made over nearly two years.

Prosecutors said over 20 people altered medical bills and submitted false claims to insurance companies from September 2013 to July 2015. With Burgess serving as the ringleader, over $400,000 of claims were made, and nearly $300,000 of those were paid by the insurance companies, was reported by the state’s attorney general.

Burgess altered her own family’s medical bills, as well as recruited and directed others to alter their medical bills for submission, investigators said. Insurance fraud investigators with the State Law Enforcement Division led the investigation. Along with the attorney general’s office prosecution team, they found Burgess responsible for $296,250.91 of restitution with her other co-defendants, the release stated.

Burgess was sentenced to 10 years, suspended upon only 90 days in jail, plus five years of probation. She was also held responsible for $60,000 in restitution of claims she filed on her own behalf. A very kind sentence.

Guilty To $3.5m Healthcare Fraud Conspiracy

Onkur Lal, 29, of Arlington, Virginia pleaded guilty October 20, 2020, to his role in a conspiracy to commit health care fraud that resulted in losses of over $3.5 million.

According to court documents, Lal worked in various roles at MedEx Pharmacy, MedEx Health Pharmacy, and Royal Care Pharmacy, which were all owned and operated by the same individual. From around 2014 to around 2019, Lal conspired with the owner and others in a number of different fraudulent schemes to defraud health care benefit programs, including TRICARE, Medicare, Virginia Medicaid, and Maryland Medicaid. Lal took part in a number of fraudulent schemes, including generating false prescriptions, billing health insurance companies for prescriptions that were never filled, and billing patients’ health care benefit programs for numerous high cost medications that he and his co-conspirators knew were not prescribed and/or never received.

Lal and his conspirators also submitted false invoices under the names of other pharmacies, in an attempt to circumvent audits. Further, Lal and another co-conspirator fraudulently posed as pharmacists by elevating their title and credentials within the pharmacy’s prescription software system. Lal and his co-conspirator then used these elevated titles to verify prescriptions, which they then submitted to health care benefit programs and pharmaceutical suppliers for payment. The various schemes resulted in health care benefit programs losing more than $3.5 million.

Lal is scheduled to be sentenced on Feb. 21, 2021, and faces a maximum penalty of five years in prison. Actual sentences for federal crimes are typically less than the maximum penalties. A federal district court judge will determine any sentence after taking into account the U.S. Sentencing Guidelines and other statutory factors.

Medical Assistant Admits Role in Genetic Testing Kickback and Bribery Scheme

Shanelyn Kennedy, 25, of Scranton, Pennsylvania, pleaded guilty by videoconference before U.S. District Judge Anne E. Thompson to an information charging her with one count of conspiring to violate the anti-kickback statute. Kennedy is the second defendant to plead guilty in bribery and kickback schemes involving doctors and medical employees in the Scranton, Pennsylvania, area.

According to documents filed in this case and statements made in court:

Kennedy worked as a medical assistant for Yitzachok “Barry” Kurtzer, a primary care physician with separate offices in the Scranton area. From at least 2018, Kurtzer and his wife, Robin Kurtzer accepted monthly cash kickbacks and bribes in exchange for collecting DNA samples from Medicare patients and sending them for genetic tests to clinical laboratories in New Jersey and Pennsylvania. The cash kickbacks ranged up to $5,000, and the Kurtzers typically accepted the cash in one of Kurtzer’s offices, at times behind locked doors.

Even as the ongoing COVID-19 pandemic substantially reduced in-patient visits, the Kurtzers continued with their scheme. They went from receiving hand-delivered cash kickbacks and bribes to accepting payments by wire and through a mobile phone money-transfer application.

Kennedy participated in the conspiracy with another employee, Amber Harris, who has previously pleaded guilty for her role in the scheme. They both helped collect the DNA swabs in exchange for also receiving kickbacks and bribes, both in cash and later using the money-transfer application.

As a result of the scheme, Medicare paid $755,241 for genetic tests generated from Kurtzer’s practice.

The count of conspiracy to violate the federal anti-kickback statute is punishable by a maximum of five years in prison and a fine of $250,000, or twice the gross gain or loss derived from the offense, whichever is greater. Sentencing is scheduled for Feb. 23, 2021.

San Diego Dentist Sentenced to Six Years in Prison for a Fraudulent Billings Scheme

General dentist, April Rose Ambrosio, 59, of Mira Mesa, California was sentenced October 21, 2020 to six years in prison after pleading guilty to three counts of insurance fraud for falsely claiming she performed 800 root canals on 100 patients in four years though she lacks the specialized training required of an endodontist to perform root canals. Ambrosio fraudulently billed multiple insurance companies nearly $900,000 to receive more than $400,000. In some cases, her alleged patients never set foot inside her office. She was ordered to pay restitution in the amount of $405,633.

A two-year investigation by the Department of Insurance, working closely with the San Diego County District Attorney’s Insurance Fraud Division, revealed from 2014 to 2018, Ambrosio fraudulently billed 10 insurance companies $866,700 for 800 root canals for 100 patients, which were never performed.

To facilitate her scheme, Ambrosio billed for work on days her office was closed or she claimed to be on vacation. For one family of four, she billed the insurance companies for more than 100 root canals over a three-month period. Ambrosio also billed for root canals performed on non-existent or missing teeth, or double billed for teeth she previously claimed to have performed root canals on.

Ambrosio never directly billed her patients for their portion of the phony dental work, which she billed to the insurance companies and resulted in a loss of over $400,000 to those companies. Ambrosio’s license to practice dentistry was suspended on September 24, 2019.

Doctor Sentenced To 70 Months in Painkiller Scheme

Dr. Eugene Gosy, 60, issued more prescriptions for controlled substances than any other prescriber in New York State. Gosy, a Clarence, New York doctor who prescribed painkillers to patients throughout Western New York was sentenced to 70 months in federal prison in October 2020 in U.S. District Court.

He pleaded guilty earlier this year to conspiracy to distribute controlled substances and healthcare fraud. Gosy prescribed opiods without conducting exams, issued prescriptions for controlled substances in dosages and combinations that harmed patients, knew patients were abusing drugs and failed to monitor patients.

He also signed death certificates without an autopsy or medical exam, signed blank prescriptions to allow others to fill them out and gave gifts and bonuses to physicians assistants and nurse practitioners who saw certain volumes of patients. Those who didn’t meet his standards were threatened with pay cuts.

Gosy’s plea laid bare his criminal indifference to the well-being and health of many of his patients and their families according to Stephen Belongia, Special Agent-in-Charge of the FBI’s Buffalo Office. Gosy’s practice of medicine placed a higher value on profit through fraud than the fragile lives of those who came to him for help.

Medical Device Maker to Pay $18 Million To Settle Allegations of Improper Payments to Physicians

Merit Medical Systems Inc. (MMSI), of South Jordan, Utah, a medical device maker has agreed to pay $18 million to resolve allegations that the company caused the submission of false claims to the Medicare, Medicaid, and TRICARE programs by paying kickbacks to physicians and hospitals to induce the use of its products, the U.S. Attorney’s Office for the District of New Jersey and the Department of Justice announced today.

The settlement resolves allegations that, for over six years, MMSI engaged in a kickback. The federal Anti?Kickback Statute prohibits offering or paying anything of value to induce the referral of items or services covered by Medicare, Medicaid, TRICARE, and other federal healthcare programs. The statute is intended to ensure that medical providers’ judgments are not compromised by improper financial incentives.

Under the guise of an internal program known as the Local Advertising Program, MMSI allegedly provided remuneration to healthcare providers in the form of millions of dollars in free advertising assistance, practice development, practice support, and purported unrestricted “educational” grants to induce the healthcare providers to purchase and use a wide variety of MMSI products. These products included MMSI’s EmboSphere devices, which generally were used for uterine fibroid embolization procedures, and its QuadraSphere devices, which generally were used for other types of embolization procedures. Despite publicly claiming that its financial assistance was designed to “increase th[e] awareness” of medical treatments, MMSI allegedly provided it only to select healthcare providers to reward past sales, induce future sales, and steer business to MMSI and away from MMSI’s competitors. The government alleged that MMSI disregarded numerous warnings that its conduct may violate the Anti-Kickback Statute, including warnings from MMSI’s own Chief Compliance Officer, during the course of the alleged kickback scheme. Of the $18 million to be paid by MMSI, $15.21 million will be returned to the federal government, and a total of $2.79 million will be returned to individual states, which jointly funded claims involving MMSI devices that were submitted to state Medicaid programs.

Along with the civil settlement, MMSI entered into a five-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services-Office of Inspector General (HHS-OIG). The CIA requires MMSI to hire a compliance expert and an independent review organization to analyze its systems and transactions.

The allegations were originally made in a lawsuit filed under the whistleblower provisions of the False Claims Act by Charles J. Wolf M.D., the former chief compliance officer of MMSI. The act permits private parties to sue for false claims on behalf of the United States and to share in any recovery. Wolf will receive $2.65 million from the federal share of the settlement.

Videos on YouTube And Zalma On Insurance from Barry Zalma

62 Videos describing important insurance issues described by Barry Zalma and available to anyone who views or subscribes to the YouTube account. Issues include insurance fraud, definition of insurance, insurance as a contract of personal indemnity, millions for defense and not a dime for tribute and the tort of bad faith. Please subscribe. The 62 videos are at https://www.youtube.com/channel/UCFg7qxC0tVgKcMUqoUfnwPw/videos bit I have had some difficulty posting new videos to my YouTube channel and have decided to post all future videos on insurance, insurance claims, insurance law, and insurance fraud to this YouTube Channel and my blog, https://zalma.com/blog.

Other Insurance Fraud Convictions

Guilty Pleas in Louisiana Staged Auto/Tractor-Trailer Crashes

Roderick Hickman, 49, of Baton Rouge; Bernell Gale, 43, of Raceland; and Troy Smith, 56, of Houma, have pleaded guilty to charges of Conspiracy to Commit Mail Fraud arising out of staged automobile accidents with tractor-trailers occurring in New Orleans.

According to the guilty plea, on March 27, 2017, Hickman, along with four defendants who have also been charged by indictment, intentionally collided with a tractor-trailer at the intersection of Chef Menteur Highway and Downman Road. Hickman intentionally struck the 18-wheeler and then fled the scene with Damian Labeaud, who pled guilty to a previous indictment charging him and seven others with staging automobile accidents.

According to documents filed in federal court, the passengers were referred to attorneys who paid Hickman and Labeaud to stage the accidents. In some cases, the attorneys knew that the participants were uninjured but referred them to medical providers for treatment to increase the value of subsequent lawsuits. In total, the victim trucking and insurance companies paid out $277,500.00 for these fraudulent claims.

Hickman, Gale, and Smith face a maximum sentence of five (5) years.

Daly City Electrician Sentenced for Workers’ Compensation Fraud

Michael Ray Williams, 37, of Daly City, was sentenced to 60 days in county jail and three years formal probation after pleading no contest to two felony counts of insurance fraud after illegally working for multiple employers while simultaneously collecting over $85,000 in workers’ compensation benefits from two different insurers. Williams repaid the State Compensation Insurance Fund (SCIF) $40,000 in restitution and was ordered to pay additional restitution to Travelers Insurance and his former employer.

In November 2014, Williams was working as an electrician when he sustained a work-related injury. He filed a workers’ compensation claim with SCIF and began collecting temporary workers’ compensation benefits.

An investigation by the California Department of Insurance revealed that in March 2015, Williams began working for a different employer, yet allegedly continued to collect payments from SCIF. In May 2015, Williams sustained another work-related injury and filed another workers’ compensation claim, this time with Travelers Insurance. Between March 2015 and November 2016, Williams allegedly worked for and was paid by three different employers. At one point, Williams was collecting payments from SCIF and Travelers for two different work-related injuries, while continuing to work.

To fraudulently collect benefits, Williams allegedly misrepresented his level of injury, abilities, earnings and employment status to SCIF and medical providers, including providing false statements to his Qualified Medical Examiner to collect permanent disability benefits after the temporary benefits were exhausted. Williams was also charged with grand theft for allegedly using his former employer’s credit card for personal expenses, including the purchase of an engagement ring.

Chicago Man Gets 99 Years in Mother’s Murder-For-Hire Killing

Qaw’mane Wilson, 30, was sentenced October 16, 2020 by a Cook County judge who also sentenced the convicted gunman, Eugene Spencer, to 100 years. Wilson, a n aspiring Chicago rapper who posted a video on YouTube of himself throwing thousands of dollars that he inherited from his mother to his “fans” has been sentenced to 99 years in prison for her 2012 murder-for-hire killing.

Both men were convicted last March of first-degree murder, attempted murder and home invasion in the killing of Yolanda Holmes, who was a hairstylist in Chicago’s Uptown neighborhood, the newspaper reported.

Prosecutors said Holmes doted on her son, an only child, lavishing him with fancy clothes, jewelry and a Mustang, but that he wanted more. Wilson, then 23, sent Spencer to his mother’s apartment to kill her in September 2012 so that Wilson could raid her bank accounts, prosecutors said.

Records showed that Wilson withdrew nearly $70,000 from his mother’s accounts in the months after her death and spent the money on flashy clothes and to customize the Mustang she had given him to have gull-wing doors added to the vehicle.

Wilson also posted on YouTube a video of himself withdrawing thousands of dollars in cash from a bank and throwing those bills to a crowd of people that he said in the video were “fans” of his rap music. That video was played for the jury that convicted Wilson, who went by the name “Young QC.”

During sentencing, he slouched in his chair and merely nodded when Sacks announced the sentence. When asked if he had anything to say before Sacks made his ruling, Wilson spoke briefly. “I just want to say, nobody loved my mother more than me,” he said. “She was all I had. That’s it.”

Convicted of Workers’ Compensation Fraud

Jeffrey Janson, 70, pleaded guilty to the fourth-degree felony in Franklin County Common Pleas Court. A judge sentenced him to six months in jail, suspended for three years of probation, and ordered Janson to pay restitution of $141,578 to BWC of Ohio.

Janson, a Washington Court House man pleaded guilty to felony workers’ compensation fraud for working while receiving more than $141,500 in benefits from the Ohio Bureau of Workers’ Compensation (BWC).

Janson was previously convicted of felony workers’ compensation fraud in July 2010.

BWC’s Special Investigations Department discovered Janson working as a semi-truck driver while receiving benefits for a workplace injury. Further review of his bank records proved he was, in fact, working for four additional employers during the same time period.

 Legal Disclaimer

ZIFL is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using ZIFL you understand that there is no attorney client relationship between you and the publisher. ZIFL should not be used as a substitute for competent legal advice from a licensed professional attorney in your state. The author and publisher disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this blog. The information provided is not a substitute for the advice of a competent insurance, legal, or other professional. The Information provided at this site should not be relied on as legal advice. Legal advice cannot be given without full consideration of all relevant information relating to an individual situation.

Consider Books to Show Your Appreciation to Your Insurer Clients or Claims Employees

Many insurers refuse to allow their employees to receive gifts from vendors.

If you wish to thank your insurance company clients for allowing you to represent their interest or if you wish to honor your claims personnel it is time to give them something that will be useful to them throughout the coming year and that will not offend insurer’s rules to avoid attempts to extort clients for business from insurer employees.

 The Insurance Claims Library

Over the last 51 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 for insurers and their claims staff to become insurance claims professionals.

Consider the Insurance Claims Library where, for a small investment you can provide each claims office – rather than individual adjusters – a group of insurance books that will help them throughout the year.

By providing clients, claims departments, or claims personnel with any one or more of the books offered by the Insurance Claims Library. By so doing you can add to the insurance claims professionalism of your clients, employees and claims personnel. With delivery handled by Amazon.com any one or more of the following books, all available from amazon.com and https://zalma.com/blog/insurance-claims-library/, will gain the respect and gratitude from each recipient and their employers.

Books Available from the Insurance Claims Library

The Homeowners Insurance Policy – How to Buy an Appropriate Homeowners Policy and Successfully Make a Claim to the Insurer; Zalma on Insurance Claims – Second Edition – Ten volumes providing a Comprehensive Review of insurance, insurance claims, the law of insurance and policy interpretation Paperback; Construction Defects and Insurance; Mold Claims; The Law of Unintended Consequences and the Tort of Bad Faith; Insurance Fraud – Volume I & Volume II; The Compact Book of Adjusting Property Insurance Claims – Second Edition; The Compact Book on Adjusting Liability Claims, Second Edition; California Fair Claims Settlement Practices Regulations; California SIU Regulations; Ethics for the Insurance Professional; Rescission of Insurance – 2nd Edition; The Insurance Examination Under Oath; and six Fictionalized True Insurance Crime Books. Available at https://zalma.com/blog/insurance-claims-library.

Books from Full Court Press

“Zalma on Property and Casualty Insurance”, “Insurance Law Deskbook”, “California Insurance Law Deskbook”, and “Insurance Bad Faith and Punitive Damages Deskbook”

Learn Everything You and Your People Need to Know About Insurance at reduced prices now only $95.00.

The Insurance Law Deskbook

The Insurance Law Deskbook is intended to help law students, practitioners, insurance lawyers, professional claims personnel, insured persons, and anyone else involved in insurance. The book, published for the first time under Full Court Press, includes the full texts and digests of insurance-related decisions of the U.S. Supreme Court, the U.S. District Courts of Appeal, state appellate courts, and foreign courts that have molded the American insurance law, as well as vital explanatory chapters, historical context, form letters, and more.

Paperback, only $95.00 available at https://www.fastcase.com/store/fcp/insurance-law-deskbook-2/

California Insurance Law Deskbook

ISBN: 978-1-949884-28-9 (Print) 978-1-949884-30-2(Ebook)

Format: Digital (Epub, Mobi, PDF), Print

California has long led the way when it comes to insurance jurisprudence in the United States, and few know more about California insurance law than Barry Zalma.

Available at https://www.fastcase.com/store/fcp/california-insurance-law-deskbook/ a paperback for only $95.00.

Insurers must bring a new crop of graduates into the insurance profession. Since most insurer-based insurance training departments have been eliminated there is a need for other means to train a new generation of claims professionals. All available at fastcase.com.

Information needed by every claims person and insured. They are available on amazon.com and at https://zalma.com/blog/insurance-claims-library/ or the individual links at each described book. Web based training is available at experfy.com and illumeo.com or you can have Barry Zalma present the training live to your personnel.

Read more about Barry Zalma, Inc. at https://www.zalma.comThe earnings of almost every civil lawyer in the United States are funded by the insurance industry. Insurance can best be described as the mother’s milk of the law profession. The civil defense lawyer is paid by an insurer for each hour he or she works. The civil plaintiffs’ lawyer is usually paid by taking a percentage of any judgment entered in favor of the plaintiff, which judgment is usually paid by the defendant’s insurer.

In almost every situation in which a civil lawyer practices law the funds for that work come, either directly or indirectly, from insurance. Consequently, lawyers must use their wits and energies to avoid or to pursue litigation to the benefit of the client. Both sides understand that an insurer will eventually pay one or both sides in the dispute. Insurance is important to every civil dispute and even some that fall within the criminal courts.

Every lawyer retained to prosecute or defend a civil suit should begin the representation with a serious effort to find insurance coverage for the benefit of the client or the defendant the client is suing. Without that knowledge, the lawyer will find he or she is litigating with duct tape firmly self-placed across his or her mouth.

Books from the American Bar Association

“Getting the Whole Truth: Interviewing Techniques for the Lawyer” by Barry Zalma, Esq., CFE

Learn techniques that can help you interact with others and effectively gather the facts you need.

The purpose of an interview is to uncover the truth; the method of uncovering the truth is the art of the interview. Obtaining sufficient relevant information is imperative in everything a lawyer does to protect the interests of the client, yet interviewing techniques are not emphasized in law school training.

Getting the Whole Truth teaches lawyers–from novices meeting their first clients to experienced trial lawyers–effective methods of obtaining information by human interaction. No matter from whom you are seeking information or what your reason for desiring it, these techniques can help you meet and interact with others and effectively gather the facts you need.

Listen to podcast about the book at https://www.americanbar.org/groups/gpsolo/podcasts/gpsolo-podcast-july-2020-hotp-interview-techniques/

$59 Non-Members, $44 Members

“The Commercial Property Insurance Policy Deskbook” By Barry Zalma

“How to Acquire a Commercial Property Policy and Present and Collect a First-Party Property Insurance Claim

The Commercial Property Insurance Policy Deskbook is a comprehensive resource on acquiring a commercial property policy and presenting and collecting first-party property insurance claims. The book looks at the fundamentals of insurance and a wealth of topics including rules of construction of a policy of commercial property insurance, the commercial first party property insurance policy, different types of property losses, conditions and limitations, specific and blanket cover.” Available here.

The Insurance Fraud Deskbook”

Author: Barry Zalma, ISBN: 978-1-62722-676-9, Product Code: 5190506, 2014, 638 pages, 7 x 10

This book is written for individuals who are focused on the effort to reduce expensive and pervasive occurrences of insurance fraud. Lawyers who represent insurers, claims personnel, prosecutors and their investigators can all benefit from this exhaustive resource.

The Insurance Fraud Deskbook is a valuable resource for those who are engaged in the effort to reduce expensive and pervasive occurrences of insurance fraud. It explains the elements of the crime and the tort to claims personnel, and it provides information for lawyers who represent insurers, so they can adequately advise their clients. Prosecutors and their investigators can use this book to determine what is required to prove the crime and win their case.

The full text of decisions from courts of appeal and supreme courts across the country are provided so the reader can understand what happens after the investigation is completed and can apply that information to undertake their own thorough investigations. It allows claims personnel and their lawyers to understand what errors would cause a defeat or a not-guilty verdict.

The effort to reduce insurance fraud requires the assistance of both civil and criminal courts.

The Insurance Fraud Deskbook can help the prudent fraud investigator, insurance adjuster, insurance attorney, insurance Special Investigation Unit, and insurance company management to attain the information needed to deal with state investigators and prosecutors.

Available from the American Bar Association at: https://shop.americanbar.org/eBus/Default.aspx?TabID=251&productId=214624; or [email protected], or 800-285-2221.

“Diminution in Value Damages”

How to Determine the Proper Measure of Damage to Real and Personal Property

ISBN: 978-1-63425-295-8

Product Code: 5190524

2015, 235 pages, 7 x 10, Paperback

Available from Thomson Reuters

“Property Investigation Checklists Uncovering Insurance Fraud, 12th Edition”

This edition has been totally rewritten and expanded, providing the most extensive and detailed coverage of the issue and a thorough explanation of how to apply diminution in value damages to losses to property. Property Investigation Checklists: Uncovering Insurance Fraud 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, and extracontractual damages. The appendix includes the NAIC Insurance Information and Privacy Protection Model Act. Also included are five appendixes of forms, letters, and other documents.

Available here

New and Now Available from the Zalma Insurance Claims Library

The Insurance Examination Under Oath Second Edition

A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud

A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud.

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 the agreement of the insurer, when he, she or it acquires a policy of insurance, to submit to a condition of the insurance contract that compels the insured to appear and give sworn testimony at the demand of the insurer. Failure to appear and testify is considered a breach of a material condition.

The EUO is conducted before a notary and a certified shorthand reporter who is present to give the oath to the person interviewed. The reporter will record the entire conversation and prepare a transcript to be read, reviewed, corrected and signed by the witness under penalty of perjury or by an oath taken before a notary or judge.

The EUO is a tool only sparingly used by insurers in the United States. A professional insurer will only require an insured to submit to an EUO when a thorough claims investigation raises questions: About the application of the coverage to the facts of the loss, the potentiality that a fraud is being attempted, or to assist the insured in the obligation to prove to the insurer the cause and amount of loss.

Although seldom used the EUO is an important tool needed by insurers when there is a question of coverage, destruction of evidence needed to prove a compensable loss or the amount of loss or evidence indicating the potential that a fraud is being attempted. The EUO and Legal Action provisions in an insurance policy are conditions precedent to an insured’s ability to file suit, and that since the insured failed to substantially comply with the terms of those provisions, the appropriate remedy is dismissal without prejudice. The insured’s failure to comply with these conditions does not bar his ability to bring suit to recover, but merely suspends his ability to bring suit until he has fully complied with those conditions.

Available as a paperback here or Available as a Kindle book here

The Little Book on Ethics for the American Lawyer

by Barry Zalma (Author)

The practice of law demands more than knowledge of statutory and case law. It requires more than technical proficiency in the nuts and bolts of legal practice. A lawyer is an officer of the legal system whose conduct should conform to the requirements of the law, both in professional service to clients and in the lawyer’s business and personal affairs.

The practice of law requires that every lawyer treat each client, each adversary, and the court ethically and in good faith.

The practice of law is different from other professions because it requires that the lawyer act for his or her client, not him or herself, only if the actions for the client are ethical and in good faith.

What is Ethical Behavior?

The concept of ethical behavior refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues, all of which are essential to the lawyer.

Ethics also refers to the study and development of one’s standards of conduct. Feelings, laws, and social norms can deviate from what is ethical. It is necessary, especially to people involved in the practice of law, to constantly examine one’s standards to ensure that they are reasonable and well-founded conduct that ethically treats a client, an adversary, and the court with the utmost good faith.

There is no single answer to the question of what is ethical behavior by a lawyer. Ethical behavior is subjective and fact dependent.

“Arson-For-Profit Fire at the Cowboy Bar & Grill”

A true crime novel based on the experience of the author, Barry Zalma, who for more than 51 years has acted for insurers who were faced with arson-for-profit, one of the most dangerous insurance fraud schemes. The book explains how an insurance claims adjuster, working with a fire cause and origin expert, a forensic accountant and insurance coverage lawyer, were able to defeat an arson-for-profit scheme and obtain a judgment requiring the perpetrator to take nothing and repay the insurer all of its expenses in defeating the claim.

Available as a paperback. Available as a Kindle book.

Rescission of Insurance – 2nd Edition

Newly updated and expanded, “Rescission of Insurance – 2nd Edition” provides the insurance coverage lawyer, policyholder lawyer and claims professionals with everything needed to understand and enforce the equitable remedy of rescission. Everyone involved in or with the business of insurance must understand that rescission is an equitable remedy as ancient as the common law of Britain. When the United States was conceived in 1776 the founders were concerned with protecting their rights under British common law. They adopted it as the law of the new United States of America modified only by the limitations placed on the central government by the U.S. Constitution approved in 1789.

The viability and ability to enforce contracts was recognized as essential to commerce. Courts of law were charged with enforcing legitimate contracts. Courts of equity were charged with protecting contracting parties from mistake, fraud, misrepresentation and concealment since enforcing a contract based on mistake, fraud, misrepresentation or concealment would not be fair. The common law developed rules that courts could follow to refuse to enforce the terms of a contract that was entered into because of mutual mistake of material fact, a unilateral mistake of material fact, the breach of warranty (a presumptively material promise to do or not do something), a material concealment, or a material misrepresentation. The remedy – called rescission – created a method to apply fairness to the insurance contract and allow an insurer to void a contract and allowed courts to refuse to enforce such a contract entered into by misrepresentation or concealment of material facts.

Available as a paperback. Available as a Kindle book.

The Law of Unintended Consequences and the Tort of Bad Faith

The concept of unintended consequences is one of the building blocks of economics. Adam Smith’s “invisible hand,” the most famous metaphor in social science, is an example of a positive unintended consequence.

Most often, however, the law of unintended consequences illuminates the perverse unanticipated effects of legislation and regulation. In 1692 the English philosopher John Locke, a forerunner of modern economists, urged the defeat of a parliamentary bill designed to cut the maximum permissible rate of interest from 6 percent to 4 percent. Insurance is controlled by the courts, through appellate decisions, and by governmental agencies, through statute and regulation. Compliance with the appellate decisions, statutes, and regulations—different in the various states—is exceedingly difficult and expensive.

The business of insurance is, unfortunately, subject to the law of unintended consequences as if it were on steroids.

Available as a paperback Available as a Kindle book

Over the last 51 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.

“Construction Defects and Insurance”

The Structure, The Construction Contract, and Construction Defect Insurance Barry Zalma has updated and re-edited his seminal work Construction Defects Coverage Guide into is the latest addition to Barry Zalma’s insurance claims series of books and articles that will form the most thorough, up-to-date, expert-authored insurance claims guide available today eight Kindle or Paperback Volumes at reasonable prices.

Thorough, yet practical, this series of books form the ideal guide for any professional who works in or frequently interacts with the insurance industry.

Claims professionals, risk managers, producers, underwriters, attorneys (both plaintiff and defense), and business owners will benefit greatly from the ten-volume guide. It is also the perfect resource for insurance educators, trainers, and students whose role requires an understanding of insurance law.

The Eight volumes include:

Volume One: The Structure, The Construction Contract, and Construction Defect Insurance

Volume Two: The Defects and understanding Insurance and Underwriting 

Volume Three: Construction Defect Policies 

Volume Four: Liability Insurance

Volume Five: The Tort of Bad Faith and Construction Defects 

Volume Six: Construction Defect Suits

Volume Seven: Tort Defenses and the Trial of a Construction Defect Case

Volume Eight: Evaluation and Settlement & Alternative Dispute Resolution

“Heads I Win, Tails You Lose”

A collection of columns originally published in the magazines “Insurance Journal,” “Insurance Week,” and “The John Cooke Insurance Fraud Report” insurance trade publications serving the insurance community in the United States that have been updated and revised.

The title, “Heads I Win, Tails You Lose” is meant to describe insurance fraud as it works in the Unites States. It means that whenever a person succeeds in perpetrating an insurance fraud everyone who buys insurance is the loser.

“Insurance Fraud”

How Lawyers & Claims People Defeat Insurance Fraud

In Two Volumes

Insurance fraud continually takes more money each year than it did the last from the insurance buying public. No one knows the actual amount with any certainty because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year. No one will ever be able to place an exact number on the amount lost to insurance fraud. Everyone who has looked at the issue knows – whether based on their heart, their gut or empirical fact determined from convictions for the crime of insurance fraud – that the number is enormous.

Volume One available as a Kindle book and a paperback.

Volume Two Available as a Kindle book and a paperback

“The Compact Book of Adjusting Property Insurance Claims – Second Edition”

A Manual for the First Party Property Insurance Adjuster

The insurance adjuster is not mentioned in a policy of insurance. The obligation to investigate and prove a claim falls on the insured. Standard first party property insurance policies, based upon the New York Standard Fire Insurance policy, contain conditions that require the insured to, within sixty days of the loss, submit a sworn proof of loss to prove to the insurer the facts and amount of loss.

The Compact Book of Adjusting Property Claims – Second Edition: A Primer for The First Party Property Claims Adjuster.

The Second edition adds new material from 2018 and 2019, is easier to use and more compact than the original.

Available as a Kindle book. Available as a paperback.

“The Compact Book on Adjusting Liability Claims, Second Edition”

A Handbook for the Liability Claims Adjuster

This Compact Book of Adjusting Liability Claims Second Edition: A Handbook for the Liability Claims Adjuster provides the new adjuster with a basic grounding in what is needed to become a competent and effective insurance adjuster. It is also available as a refresher for the experienced adjuster. Available as a Kindle book Available as a paperback.

Read about these and other insurance books by Barry Zalma at https://zalma.com/blog/insurance-claims-library/

Excellence in Claims Handling Courses From Experfy.com

The Excellence in Claims Handling program provides everything a person or entity presenting a claim needs to effectively present the claim and provides the insurance claims person with everything he or she needs to properly represent the insurer.

The insured, risk manager, or corporate counsel will be able to present a first party property claim - whether a fire, theft, or windstorm or some other insured against cause - with little difficulty and professionalism and present a sworn proof of loss acceptable to an insurer.

The insurance claims person completing the course will be able to conduct a thorough investigation of the policy and claim. The insurance claims person will also be able to assist an insured to fulfill all of the promises made by the insured to the insurer and the insurer to provide the indemnity promised by the insurance policy.

The series of courses was designed so that the student can obtain the needed information easily while he or she sits down in the morning for a first cup of coffee or any other time in the day in short, easy to consume lessons. For instance, “Insurance and Claims” is made up of three modules and 27 lectures while “Investigating the Property Claim” is made up of four modules and 65 lectures. You can review each course, each module and each lecture at the links below.

Each person completing the course will be able to claim that he or she is a professional first party property claims person ready to provide excellence in claims handling and be ready to resolve any claims problem that arises for the benefit of the insurer and the policy holder.

A key to every insurance claim is the thorough investigation required by law where the insurer’s adjuster or claims person works with the insured or his, her or its representative, to gather sufficient facts to determine the cause and origin of the claimed loss, whether the loss was due to a cause, the risk of loss of which was insured, and if so to determine the extent of the loss and the indemnity owed by the insurer to the insured.

https://www.experfy.com/training/coursesWhat will students need to know or do before starting this course?

That they want to know how to understand insurance and how the law applies to insurance contracts.

The course is capable of providing information needed without the assistance of material or software. However, it can be supplemented by books written by the author and available at https://www.zalma.com/blog/insurance-claims-library/ with materials like The Homeowners Insurance Policy, Zalma on Insurance Claims - ten Volumes, Construction Defects and Insurance, Mold Claims, and “Insurance Fraud & Weapons to Defeat Insurance Fraud,” The Compact Book of Adjusting Property Insurance Claims-Second Edition; Construction Defects and Insurance (eight volumes); Mold Claims (four volumes); Ethics for the Insurance Professional; Rescission of Insurance; The Insurance Examination Under Oath; Zalma on Property and Casualty Insurance; Insurance Law Deskbook; Insurance Bad Faith and Punitive Damages Deskbook; The Commercial Property Insurance Policy Deskbook; The Insurance Fraud Deskbook; Diminution in Value Damages; and Property Investigation Checklists Uncovering Insurance Fraud, 12th Edition.

 Who should take this course? Who should not?

The course should be taken by risk managers, corporate counsel, insurance claims management, insurance claims executives, insurance claims adjusters, insurance claims representatives, insurance special investigation unit investigators, public insurance adjusters, insurance coverage lawyers, insurance paralegals, and claims personnel of insurance agencies or insurance brokerages.

Insurance and Claims:  https://www.experfy.com/training/courses/insurance-and-claims

Investigating the Property Claims: https://www.experfy.com/training/courses/investigating-the-property-claim

Insurance Law: https://www.experfy.com/training/courses/insurance-law

Solving Claims Problems: https://www.experfy.com/training/courses/solving-claims-problems

Zalma on Insurance Videos

Description Zalma on Insurance

Over the last 52 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created a library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals available at https://zalma.com/blog/insurance-claims-library/. My original channel does not allow me to add posts so I have created a new channel, Barry Zalma available at Zalma on Insurance Videos where I post a new video almost every day.

Some videos available include:

The California Fair Claims Settlement Practices Regulations 2020

A Video Explaining Why Rescission Is a Remedy That Must be Used with Care

Some Cases Where Insurers or Insurance Agents or Brokers Were Convicted of Insurance Fraud

The California Fair Claims Settlement Practices Regulations 2020

A Video Explaining Why Rescission Is a Remedy That Must be Used with Care

Some Cases Where Insurers or Insurance Agents or Brokers Were Convicted of Insurance Fraud

A Video Explaining How to Deal with Insurance Fraud and Innocent Co-Insureds

A Video Explaining an Insurer’s Dispute or Denial of a Claim

? 2020 – 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 52 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 52 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.

https://zalma.com/zalmas-insurance-fraud-letter-2/Read last two issues of ZIFL here. 

Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921

Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts

Listen to the Podcast: Zalma on Insurance  https://anchor.fm/dashboard/episodesZalma on Insurance 

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/

https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkV7pkuOtkiv6oakpgK33CNlNAYW-WBlLCOZFtgvpSdcL7R-tsWKfMVqG6fEuvmM7Hh7gUEJ7yKOdgHDbGl_cGAU%3De-mail Version of ZIFL, it’s Free! –