Zalma's Insurance Fraud Letter - August 1, 2024

ZIFL Volume 28 Issue 15

Post 4847

The Source for the Insurance Fraud Professional

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

Guilty of Workers’ Compensation Fraud
Inflating On-The-Job Injury is Fraud

A jury found Waliullah Nazari guilty of two counts of making false and fraudulent statements for the purpose of obtaining workers’ Compensation benefits and seven counts of attempted perjury under oath.

In The People v. Waliullah Nazari, D081940, California Court of Appeals, Fourth District, First Division (July 18, 2024) the Court of Appeals affirmed the conviction because surveillance proved Nazari had lied to his physician and insurer.

Read the full issue of ZIFL and the full article here http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-08-01-2024.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 not occur, is sometimes too difficult for normally honest people to resist.

Each year, the effect of insurance fraud runs to billions of dollars. It is estimated that insurance fraud takes between 33 and 38 percent of the premiums collected and annually drains as much as $300 billion or more from the assets of insurers in the United States.

Insurance fraud occurs when a person or entity makes false insurance claims in order to obtain compensation or benefits to which they are not entitled. Insurance fraud is committed in many forms, but regardless of the type, it is considered a serious crime in all jurisdictions.

Read the full issue of ZIFL and the full article here http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-08-01-2024.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s thirty 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.

July 9, 2024

The law firm, Morris Bart filed a Complaint for Injunctive Relief and for Declaratory Judgment against MMA in the Eastern District of Louisiana years ago.

Health Insurance Fraud Convictions

Help to the DOJ From Whistleblower/Qui Tam Suits

$2.45 Million Health Care Fraud Settlement

Vista Clinical Diagnostics, LLC, for allegedly submitting or causing the submission of false claims to Medicare and Medicaid programs in North Carolina, Virginia, and Florida. These settlement funds will be returned to the Medicare and Medicaid programs.

From Jan. 1, 2017, through Dec. 31, 2021, Vista Clinical allegedly submitted or caused to be submitted reimbursement claims to Medicare and Medicaid by adding diagnosis codes into patients’ reimbursement submissions that had not been provided by those patients’ physicians.

Read the full issue of ZIFL and the full article including dozens of settlements and convictions here http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-08-01-2024.pdf

The Reasons for an Examination Under Oath

The EUO Is Not an Adversary Proceeding like a Deposition in a Lawsuit.

The Examination Under Oath (EUO) is an investigative tool made available to the insurer. It allows the insurer to delve deeply and under oath into all aspects of the policy and the loss. The testimony to be elicited is not constrained by rules of discovery or the Codes of Civil Procedure.

The only restraint on the EUO is reasonableness although some courts do not even include a reasonableness standard. Regardless, the person taking the EUO must always act reasonably while understanding that unlimited questions are allowed. Only irrelevant and unreasonable questions dealing with facts completely outside the policy, its acquisition or the loss are not favored.

Read the full issue of ZIFL and the full article here http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-08-01-2024.pdf

Barry Zalma

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

Read the full issue of ZIFL and the full article here http://zalma.com/blog/wp-content/uploads/2024/07/ZIFL-08-01-2024.pdf