The Source for Insurance Fraud Professionals
Read the full issue of ZIFL-04-15-2023
Watch the full video at https://rumble.com/v2i01ci-zalmas-insurance-fraud-letter-april-15-2023.html and at https://youtu.be/hZBklODzDy8
Obesity, diabetes and covid not grounds for compassionate release
USA Congress, feeling sorry for federal prisoners, amended the law to create The First Step Act to allow a district court to shorten a sentence when there are extraordinary and compelling reasons to release the prisoner. IN United States v. Earl Lee Planck, Jr.Criminal No. 5:20-CR-24-KKC-MAS-1, United States District Court, ED Kentucky, Central Division, Lexington (March 1, 2023) Earl Lee Planck, Jr moved USDC for compassionate release under the statute.
Read the full issue of ZIFL-04-15-2023
The special investigation unit’s investigator
Insurance companies now retain the services—either by hiring them directly or by using independent contractors—of investigators whose expertise relates exclusively to insurance claims and suspected insurance fraud. The experienced claims adjuster is usually part of, or a supplier to, a special investigation unit (SIU) established to protect the insurer and mandated by most states as a means of reducing the amount of fraud committed against insurers.
However, the fact that an insured is contacted by a claims investigator does not mean that the insured is suspected of fraud. Because of their training and experience, the claims adjuster is more skilled than the adjuster in discerning facts and evidence that can be used in a court of law if fraud has been attempted.
Read the full issue of ZIFL-04-15-2023
More problems with McClenny Moseley & Associates
This is ZIFL’s fourth installment in the saga of McClenny, Moseley & Associates and its trouble with the federal courts in the state of Louisiana and what appears to be an attempt to capitalize on what some judges and district judges indicate may be criminal behavior to capitalize on . insurance claims related to hurricane damage to the public in the state of Louisiana.
Chutzpah defined
“Chutzpah” is a Yiddish term that has found its way into the English language. It is defined as “unrepentant bile” and is usually explained as a person convicted of murdering his parents who appealed to the judge for mercy because he is an orphan. The latest action by McClenny Moseley & Associates is a better definition of the term.
Read the full issue of ZIFL-04-15-2023
Free insurance videos
Barry Zalma, Esq., CFE has posted five days a week videos on insurance claims, insurance claims laws, insurance fraud and insurance coverage at https://www.rumble.com/zalma.https://rumble.com/c/c-262921.
He now limits his practice to that of an insurance consultant specializing in insurance coverage, insurance claims management, insurance bad faith and insurance fraud almost equally for insurers and he practiced law in California for more than 44 years as an insurance coverage and claims management attorney and more than 55 years in the insurance industry. He can be reached at http://www.zalma.com and zalma@zalma.com.
Read the full issue of ZIFL-04-15-2023
The problem of different degrees of crime
Fraud by any other name is still fraud
Under the New Jersey Code of Criminal Justice (Code), one can be charged with the crime of insurance fraud for knowingly making a false or misleading statement of material fact in connection with an insurance claim. The third-degree felony can be elevated to the second degree by compiling five “acts” of insurance fraud, the total value of which exceeds $1,000.
IN State Of New Jersey v. Randi Fleischman, A-4 September 2006, Supreme Court of New Jersey (March 26, 2007) the New Jersey Supreme Court was given its first opportunity to construe NJSA 2C:21-4.6’s criminalization of a false “statement” as an “insurance fraud” which can be accumulated to raise insurance fraud to a second degree misdemeanor.
The State charged defendant Randi Fleischman with second degree insurance fraud. The factual basis for the charge was based on various elements of false information in the defendant’s statements to the police and to her auto insurance company in connection with a stolen car.
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Good news from
A home health care company has paid $9 million for filing false claims. United Energy Workers Healthcare, Corp. and related entities settled a claim with several entities, including Ohio, to employees of the US Department of Energy and its contractors. An investigation stated: between January 2013 and March 2021, defendants submitted claims for payment for home health care that was never provided or was medically unnecessary, in violation of the False Claims Act. Several of the violations include: billing for case management services not actually provided, instructing providers to charge for more time than they actually spent with patients, providing and billing services to beneficiaries who were not covered, and providing services without having the necessary licenses. Plus many more convictions for fraud.
Read the full issue of ZIFL-04-15-2023
LIABILITY OF ATTORNEYS WHEN A CLIENT IS SUSPECTED OF FRAUD
A lawyer who suspects that his or her client is lying about facts to cover up fraudulent or criminal activity puts the lawyer in a professional dilemma. The customer may fake injuries after a car accident or make up the cause of a fire in his or her home. Or the client provides the attorney with intentionally vague information about their finances to avoid reporting the information to the IRS or other government agency.
In July 2021, the Colorado Bar Association Ethics Committee adopted Formal Opinion 142, which addresses a lawyer’s duty to inquire when the lawyer knows that a client is seeking advice on a transactional matter that may be criminal or fraudulent. Like the equivalent of the Model Rules of Professional Conduct, Colorado Rule 1.2(d) provides that a lawyer “shall not advise a client to engage, or assist a client, in conduct which the lawyer knows to be criminal or fraudulent . . .”
The opinion specifically discusses what happens when the lawyer suspects but don’t do it actually know, that the client may use the legal services to engage in criminal or fraudulent conduct. While the term “know” denotes “actual knowledge of the fact in question” under Colorado Rule 1.0(f), the Committee interpreted the actual knowledge standard to include “willful blindness.”
Read the full issue of ZIFL-04-15-2023
Health insurance fraud convictions
Santa Rosa doctor sentenced to 2.5 years in prison for illegal prescription of controlled substances
Thomas Keller, former pain management physician in Santa Rosa, was sentenced to 30 months in prison for distributing schedule II and IV controlled substances outside the scope of his professional practice and without a legitimate medical need. The verdict was delivered by the Hon. U.S. District Judge Vince Chhabria after a jury found Keller guilty of the crimes at trial in November 2022. Read about this and dozens of other convictions.
Read the full issue of ZIFL-04-15-2023
Other insurance fraud
Richfield woman sentenced to 10 years behind bars for insurance fraud
The insurance department became aware that she was again embezzling funds with the new agency.
Charlotte Sheppard from Richfield, Idaho is headed to prison after committing insurance fraud. Sheppard allegedly stole her clients’ insurance premiums to pay her personal and business bills and obligations.
She was sentenced to the Idaho Department of Corrections for 10 years, with five years fixed and five years indeterminate.
Sheppard was first charged and found guilty in Blaine County of grand larceny in 2020. However, while awaiting criminal sentencing and administrative penalties, she took over leadership of a second agency in Lincoln County. The Department of Insurance became aware that she was again misappropriating funds with the new authority. The DOI issued a cease and desist order on March 18, 2020, and revoked her license two days later. Also many more reports of convictions.
Read the full issue of ZIFL-04-15-2023
Barry Zalma
For the past 55 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; 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 Zalma On Insurance podcast at https://anchor.fm/barry-zalma; Follow Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos on 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 management.
Read the full issue of ZIFL-04-15-2023
