Zalma’s Insurance Fraud Letter – 10/15/2022

Watch the full video at https://rumble.com/v1nti9e-zalmas-insurance-fraud-letter-10-15-2022.html and at https://youtu.be/wGVzbQ8Gs-w

You can read all 18 pages of volume 26 issue 2o here.

Short teases about the articles in this issue can be read at ZIFL-10-15-2022

1. Ethics & Insurance Fraud
   1. Insurance fraud is a crime in most jurisdictions. In California, it is a felony punishable by five years in prison upon conviction. By definition, a person who commits the crime of insurance fraud is not acting ethically. IN State v. Whitaker175 P.3d 136, 117 Hawai=i 26 (Haw. App. 12/31/2007) Whitaker, after making a claim against his insurer, was indicted, convicted and sentenced for insurance fraud in violation of Hawaii Revised Statutes (HRS) ‘ 431:10C-307.7(a)(1) and (b)(2) (2005), and attempted theft in the second degree (attempted theft 2) in violation of HRS ‘ 708-831(1)(b) ) (Supp. 2000) and HRS ‘705-500 (1993).
2. The RICO ruling allows damages on deferment
   1. Fraudsters must remove profits from crime – IN Diane Creel and Lynn Creel v. Drs. Says, LLC, et al., Civil Action No. 4:18-CV-00615, United States District Court, ED Texas, Sherman Division (September 27, 2022), the plaintiff obtained a judgment against the defendants Drs. Yupo Jesse Chang; MD Reliance, Inc.; Universal Physicians, PA; Dr. Says, LLC; Office Winsome, LLC; and Yung Husan Yao (a.k.a. Angela Yao) for violations of the Racketeer Influenced and Corrupt Organizations Civil Code (“RICO”) and the RICO conspiracy. The court must, after judgment, enter its findings of fact and conclusions of law regarding equitable disgorgement.
3. New California Statute of Frauds

   1. SB 1040authored by Senator Susan Rubio, authorizes the Insurance Commissioner to order refunds from people selling insurance policies without the required license from the Department of Insurance, including “extended vehicle warranties” illegally sold through robocalls and misappropriation of consumer and business premiums, among other insurance fraud.

4. Good news from the Coalition Against Insurance Fraud
   1. Dead patients couldn’t stop Thomas G. O’Lear from charging taxpayers $3.7 million for fraudulent X-rays in the Indianapolis area. O’Lear ran a portable x-ray company that zapped patients in nursing homes, skilled nursing homes and long-term care facilities. He billed for thousands of x-rays that he and his company did not perform. It included 151 radiographs on dates after the patients had died. He also billed Medicare and Medicaid for wards services on dates when patients were either hospitalized and not on site at the facilities. O’Lear took multiple X-rays during one visit and falsely claimed that each was done on a different day, requiring separate reimbursement for transportation of the portable equipment on each date. And he falsely billed for multiple images of patients when only one image was taken – necessitating a higher reimbursement. O’Lear covered up his scheme by falsifying medical records, falsifying X-rays and forging signatures of his employees and the doctor he said had ordered the X-rays.
5. The insurer collects the profit from fraud

   1. Insured’s Right to Fire Insurance Benefits Defeated by Qui Tam Claim from Insurer

      IN Lisa A. McCullough v. Metlife Auto & Home, No. 4:20-CV-01807, United States District Court, MD Pennsylvania (September 30, 2022) McCullough sued to try to compel MetLife to pay the plaintiff for an insurance policy on McCullough’s home, which was destroyed in a 2019 fire.

6. A resource for insurance professionals
   1. After practicing insurance law for over five decades, Barry Zalma, an internationally recognized and award-winning insurance expert and author, releases several educational books on Amazon.com. The publications are designed to inform claimants, special investigation unit investigators, coverage attorneys, bad faith plaintiffs’ attorneys, insurance administration, and the general public of policy buyers about insurance claims procedures and insurance fraud. Each resource benefits from key insights and lessons learned from Zalma’s 55+ years of practical experience as a tort claim and insurance attorney.
7. INSURANCE CASE AWARDED DAMAGES FOR FRAUD
   1. Insured entitled to fire insurance benefits defeated by Qui Tam Claim by insurer == IN Lisa A. McCullough v. Metlife Auto & Home, No. 4:20-CV-01807, United States District Court, MD Pennsylvania (September 30, 2022) McCullough sued to try to compel MetLife to pay the plaintiff for an insurance policy on McCullough’s home, which was destroyed in a 2019 fire.
8. Health insurance fraud convictions
   1. Doctor admits to illegally prescribing 120,000 opioid pills – Dr. Dzung Ahn Pham of Tustin, Calif., pleaded guilty to writing prescriptions for more than 120,000 opioid pills over a six-year period, including an impaired driver who hit and killed a bicyclist. In his agreement, Dr. Pham that he distributed the pills without a legitimate medical purpose in exchange for cash and insurance payments. He pleaded guilty in October to conspiracy to distribute controlled substances, the Orange County Register reported. Pham faces up to 20 years in federal prison when he is sentenced on January 6, 2023.
9. Other insurance fraud
   1. One-time brewery owner and financial adviser found guilty of murdering client for life insurance benefits — Keith Todd Ashley, 50, was found guilty by federal jurors in the Eastern District of Texas on charges of wire fraud, mail fraud, carrying a firearm in connection with a crime of violence and bank fraud. Ashley, a North Texas man, was found guilty of multiple fraud-related crimes in federal court earlier this week. Prosecutors say the scams were part of an extensive series of crimes that eventually came to include a murder and cover-up orchestrated to obtain life insurance benefits.

Barry Zalma, Esq., CFE, now limits his practice to serving as an insurance consultant specializing in insurance coverage, insurance claims management, 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 attorney and more than 54 years in the insurance industry. He can be reached at http://www.zalma.com and zalma@zalma.com.

For the past 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 enable insurers and their claims professionals to become insurance claims professionals.

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

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