Zalma's Insurance Fraud Letter - April 1, 2023

ZIFL Volume 27, Issue 7 - http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

The Source For Insurance Fraud Professionals
Louisiana and Texas Charge Public Adjuster
Not an April Fools Story

Andrew Joseph Mitchell, was indicted by a grand jury in Kimble County, Texas on a second-degree forgery charge for allegedly signing the names of property owners on settlement checks so he could keep the funds for himself. Mitchell is currently jailed in Louisiana after being charged with running a similar scheme in Louisiana.

Read the full article and the full  issue at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

The Victims of Fraud

Virtually anyone can fall prey to fraudulent crimes. Con artists do not pass over anyone due to such factors as a person’s age, finances, educational level, gender, race, culture, ability, or geographic location. In fact, fraud perpetrators often target certain groups based on these factors. Very often insurers are the victims of fraud.

Read the full article and the full issue at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s third installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. The article will include details on the Suspension of Richard William Huye III by the Louisiana Supreme Court;  The order of Judge James D. Cain, Jr. Suspending MMA from practice in the federal court; Two class action lawsuits filed against MMA and it lawyers; an order from Judge North regarding violation of Rule 11 that started out: "When ego and greed become lawyers’ guiding principles, we get cases like Franatovich versus Allied Trust.”  You can read the full 28 page report at https://www.linkedin.com/in/matthewdmonson/recent-activity/all/; a race discrimination suit filed against MMA; the order of Judge Brian K. Abels restraining MMA from spending any fees collected; the disappearance of MMA from Louisiana; a suit by Apex Roofing against Huye for malpractice; and Huye's filing of withdrawal as counsel in multiple suits using MMA letterhead.

Read the full article and the full issue at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

Free Insurance Videos

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Good News from the Coalition Against Insurance Fraud

Multiple reports of insurance fraud convictions including the following: Estranged from his wife, Scott Lee Smith shot her for $1M of life insurance in Littleton, Colo. He filed for divorce from Nok just 11 days before shooting her in the basement of her home. Smith called 911 after shooting Nok in the face, lying she attacked him with a butcher knife. Yet he had no visible injuries, nor were there signs of a struggle. All three security cameras — which would’ve shown the shooting — were missing. Smith had called his mother after being taken into custody, asking her to recover the cams. Officials also found Smith and his father moving belongings from the house into two vehicles after he was released from custody. And inside the home, they found a duffel bag that was packed for a move elsewhere. Smith also showed “concerning behavior” in the months before shooting Nok. He surveilled her, set odd calendar reminders and obsessed over what would happen to her money once their pending divorce was finalized. Nok told family and friends that she was afraid of Smith and was trying to escape him. She allowed him to live in the basement of the home while she stayed upstairs. Smith received 30 years in prison. His mother is charged as an accessory, plus other crimes.

Read the full article and the full issue at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

How to Add to the Professionalism of Insurance Claims Personnel

Every insurer, insurance syndicate, insurance brokerage, insurance sales agency, insurer branch office, and vendors to the insurance industry should add to the libraries of their various offices or employees. See “Excellence in Claims Handling” at https://barryzalma.substack.com/welcome.

Read the full article and the full issue at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

What is Insurance Fraud?

Insurance fraud is the most popular and perpetrated crime in the world next to, perhaps, tax fraud. The possibility of a tax-free profit, coupled with the commonly held belief (supported by actual arrest and conviction records) that criminal prosecution will probably not occur, is sometimes too difficult for normally honest people to resist.

Read the full article and the full issue at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

Health Insurance Fraud Convictions
Hundreds Of Millions of Potential Liability Result from Federal Jury False Claims Act Verdict

Cameron-Ehlen Group, Inc., which does business as “Precision Lens,” and its owner, revealing a prime example of the significant interplay between the Anti-Kickback Statute (“AKS”) and the False Claims Act (“FCA”), a federal jury has returned a verdict of more than $43 million in damages against the Cameron-Ehlen Group, Inc. The verdict in this long-running and closely watched fraud case out of the U.S. District Court for the District of Minnesota comes after a six-week trial, with the jury ultimately finding that the defendants paid kickbacks to ophthalmic surgeons to induce their use of defendants’ products in cataract surgeries reimbursed by Medicare, resulting in the submission of 64,575 false claims between 2006 and 2015.

Read the full article including dozens of convictions and the full issue at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

Other Insurance Fraud Convictions

Sady Ribeiro, 72, was sentenced to 36 months in prison for his participation in a scheme to obtain fraudulent insurance reimbursements and other compensation from fraudulent trip-and-fall accidents, by U.S. District Judge Sidney H. Stein. During the course of the fraud scheme, Ribeiro and others attempted to defraud their victims of more than $31 million.

Riberio, a New York-licensed pain management was also sentenced to three years of supervised release.

Ribeiro pleaded guilty last October before Judge Stein. Four other co-conspirators also previously pleaded guilty for their involvement in the same scheme, and three were convicted at trial in May 2019 for their participation  and sentenced in May 2020.

Read the full article including dozens of convictions and the full issue at http://zalma.com/blog/wp-content/uploads/2023/03/ZIFL-04-01-2023.pdf

It’s Time to Subscribe to Locals or Substack
For Subscribers Only I Have Published Special Insurance Videos

I publish on Locals.com more than 30 videos and two webinars of the Excellence in Claims Handling program. I also publish on Substack.com videos and webinars of the Excellence in Claims Handling Program available only to Subscribers. The subscribers have access to all the videos and a webinar on “The Examination Under Oath A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud” among others. The videos start with the history of insurance and work their way through various types of insurance and how to obtain and deal with insurance claims. Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe. Subscribe to my publications at substack at substack.com/refer/barryzalma Go to substack at substack.com/refer/barryzalma

Barry Zalma

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

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

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