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Home / Insurance / Zalma's insurance fraud letter – 15 November 2021

Zalma's insurance fraud letter – 15 November 2021



Ohio Court allowed insurance offender to change felony to misdemeanor only to face an appeal

Sandy Diane Pinney appealed to the court on March 202 in Ashula County, Common Court. Pleas in law dismissing her application for dismissal due to delay before the prosecution, and the judgment of 30 March 2021, which sentenced her to twelve months' Community probation in a case of insurance fraud. I State of Ohio v. Sandy Diane Pinney, 2021-Ohio-3483, no. 2021-A-0013, Court of Appeals of Ohio, Eleventh District, Ashtabula (September 30, 2021) Ohio Court of Appeal addressed the claim.

FACTS

Ms. Pinney, a rather incompetent insurance fraudster, in October 2018 staged a case of a broken egg while shopping at Wal Mart. To her great surprise, she was actually injured and had a broken ankle. Wal Mart denied her insurance claim and she received no financial compensation. An investigation was filed with the prosecutor's office in 2019.

Meanwhile, in August 2021, Pinney was charged with an unrelated crime for which she pleaded guilty and served a twelve-month sentence. In October 2020, following her release in the unrelated case, the state prosecuted her for insurance fraud in violation of R.C. no of the ability to argue for a simultaneous sentence, or from seeking a negotiated basis that would have closed the case before she was released from prison. In addition, she claimed that even if the events occurred in 2018, there are convictions on her register in 2021, after the 2019 prison sentence had been completed. The district court ignored her claim and found that there was no evidence that the state was negligent or intentional in the delay, and that the appellant failed to show prejudice when preparing her defense due to the delay.

In March 2021, Pinney struck a verdict. judgment on the way, withdrew his admission of innocence and agreed to a prosecution report to a modified indictment, insurance fraud, in violation of RC 2913.47 (B) (1), a first-degree offense. By doing so, she avoided imprisonment and the court sentenced her to a twelve-month period of community control.

New Jersey's IFPA assists victims of fraud Sue the Fraudsters

Aetna Health Inc. and Aetna Life Insurance Co. (collectively, "Aetna") appeal against a court decision dismissing their second amended complaint for failure to make a claim, and rejecting their request for leave to file a third amended complaint against the father-daughter defendant Robert W. Kerekes ("Kerekes") ) and Susan Nicoll ("Nicoll"). The two were minority owners of Biodiagnostic Laboratory Systems, LLC, ("BLS"), which submitted millions of dollars of fraudulent claims to Aetna. David Nicoll ("David") – Nicoll's husband and Kerek's son-in-law – was the BLS's majority owner and was convicted of various federal crimes related to the fraud, along with other Nicoll and Kerek's family members and many doctors who participated in the plan.

I Aetna Health Inc. and Aetna Life Insurance Company v. Biodiagnostic Laboratory Services, LLC, et. al., no. A-3335-17, Superior Court of New Jersey, Appellate Division (October 7, 2021), the Appellate Division declared that the statutory provisions require less detailed submissions than a common law fraud case.

Two convicted of embezzlement of over $ 777,000 from Native American Addiction & Counseling Center

Fredericka DeCoteau, 63, Cloquet, Minnesota, and Edith Schmuck convicted 2 R, Lake, Wisconsin 2, October 77,025 2021 in federal court in Madison, Wisconsin for theft of federal software.

United States District Judge William M. Conley sentenced DeCoteau to 2 years in prison and Schmuck to 1 year and 1 day in prison. Judge Conley also ordered the defendants to jointly pay $ 777,283. Both defendants were ordered to report to the Bureau of Prisons on December 29, 2021. To begin serving their sentences. Ain Dah Ing (ADI) who has served as a non-profit halfway house in Spooner, Wisconsin since 1971. DeCoteau worked as CEO of ADI from 2002 to 2017. Schmuck worked as an accountant from 1990 to 2017. They were fired after the thefts were discovered.

ADI provided mental health and alcohol and substance abuse services to Indians of the tribes of Michigan, Minnesota, and Wisconsin. ADI's services included a 90-day program at its 15-bed premises-based residential facility in Spooner, Wisconsin. ADI's funding came from a federal commercial contract with the U.S. Department of Health and Human Services, Public Health Service, Indian Health Services Division.

Both DeCoteau and Schmuck pleaded guilty to embezzling a total of $ 777,283 from ADI by pay out unauthorized bonuses to themselves via paychecks signed with a rubber signature stamp from the ADI Treasurer. The embezzlement lasted from 2007 to 2017.

In today's judgment, Judge Conley noted that DeCoteau and Schmuck stole over 67% of the total funds earmarked for programming at ADI, and that they wasted most of that money at local Indian casinos. Judge Conley testified that the defendants violated the trust of the ADI Board and exploited vulnerable people with substance abuse. By sentencing, Judge Conley made it clear to the two defendants that the seriousness of the crime, coupled with the long-standing nature of the embezzlement, meant that they would serve time in prison despite their claims of gambling addiction.

Life sentence for Man in Fort Worth who was found guilty of the cruel murder of his wife, the infant son

Craig Vandewege 40, was found guilty on Thursday and received an automatic life sentence without the possibility of conditional release.

Vanderwege, a fort. Worth man was charged with, and convicted by a jury, for the murder of his wife and infant. He was found guilty on November 4, 2021 and was automatically sentenced to life without the possibility of parole. of insurance claims, bad faith and insurance fraud almost equally for insurers and policyholders.

He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as a lawyer for insurance coverage and claims management and more than 54 years in the insurance industry.

Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.

He is available at http://www.zalma.com and zalma@zalma.com. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award. For the past 53 years, Barry Zalma has devoted 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 claimants to become professionals in insurance claims.

Go to the training available at https://claimschool.com; articles at https://zalma.substack.com, 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 https://www.rumble.com/zalma; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ T the last two issues of ZIFL are available at https://zalma.com/zalmas-insurance-fraud- letter -2 / podcast now available at https://podcasts.apple.com/us/podcast/zalma-on-insurance/id1509583809?uo=4


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