Zalma’s Insurance Fraud Letter – August 15, 2022

ZIFL Volume 26, Issue 16

Watch the full video at https://rumble.com/v1fv6q7-zalmas-insurance-fraud-letter-august-15-2022.html and at https://youtu.be/lnmoKpDhBp8

How the UK handles the programme

Timothy schools61, a corrupt non-prosecuting barrister known in the UK as a ‘solicitor’ who lived a life of luxury on an estate in Cumbria as he fleeced investors of more than £25million, is facing jail.

Southwark Crown Court heard how Schools, raa scheme for financing loans to law firms in “no win no fee” cases between December 2008 and October 2012. The jury reached a verdict in the case only after 28 hours of deliberation.

Schools will be sentenced at Southwark Crown Court on Thursday August 18 and will remain in custody until that date. Judge Beddoe was quoted as telling Schools: “I simply do not trust that you will appear. I refuse bail and you will be remanded in custody until Thursday.”

Insurers licensed or operating in California must submit their SIU annual reports as recently as Wednesday, September 28, Insurance Commissioner Ricardo Lara recently reminded insurance companies. Failure to submit a report by 23:59 may result in fines or other regulatory action. Information about the annual report requirement is available on CDI’s website. Insurers can access an electronic portal to submit reports.

Insurers licensed or operating in California must ensure that all of their claims personnel have read, understood or been trained in the California Fair Claims Settlement Practices Regulations by September 1st of each year and be prepared to swear under oath that the regulation has been followed by insurers.

“California Fair Claims Settlement Practices Regulations 2022” which is now available as Kindle book and available as paperback.

“Soft Deception”

Insurance Soft fraud, of course, is a misnomer. Fraud is fraud – a misrepresentation or concealment of material facts, made to mislead an insurer, which actually misleads the insurer to its detriment. Those who use the term “soft fraud” attribute it to fraud of opportunity — such as adding a legitimate claim to recover deductibles or premiums paid over the years — while “hard fraud” is fraud that is premeditated.

In the US, fraud attempts have increased by about 22%, an amount that is much lower than the global average but still on the plus side.

Weston Property & Casualty Insurance Co. is insolvent and should be placed in bankruptcy, making it the fifth property insurer in Florida this year to dissolve, according to state regulators.

On August 2, 2022, the Florida Office of Insurance Regulation (OIR) notified the Department of Financial Services that 10-year-old Weston, with approximately 22,000 policies in the state, “is insolvent or about to become insolvent” and DFS should initiate criminal proceedings.

For example: Inform Diagnostics agrees to pay $16 million to settle allegations of medically unnecessary tests under the False Claims Act

Inform Diagnostics, Inc., (Inform) formerly known as Miraca Life Sciences, Inc. (Inform), has agreed to pay $16 million to settle allegations that it submitted false claims for payment to Medicare and other federal health care programs.

Inform is a clinical laboratory headquartered in Irving, Texas that provides anatomic pathology services to physicians throughout the United States. On April 27, 2022, Fulgent genetics bought Inform, and the company is now a wholly owned subsidiary of Fulgent genetics.

For example: Wellman Dynamicsa Creston company that makes large metal castings used by military contractors including Bell Helicopter, Sikorsky Aircraft and Boeing Co. will pay $500,000 in restitution to the U.S. government to settle allegations that the southwest Iowa company that makes metal castings used by military contractors in helicopters and other equipment has reached a settlement in a lawsuit that claims the company failed to test castings and falsely certified test results over seven years.

IN Fremont Indemnity Co. v. Superior Court (1982) 137 Cal.App.3d 554, 559, 187 Cal.Rptr. 137 the Court of Appeals concluded that the privilege against self-incrimination on substantive issues, specifically the application of the arson exception, was waived by suing for rights under fire insurance. The reasoning for cases like these is that “‘[t]he gravamen of [the] mood is so inconsistent with the continued claim of [a] privilege to compel the conclusion that the privilege has in fact been waived.”

While the Fifth Amendment privilege of an accused criminal is absolute, a party or witness in a civil proceeding “may be required either to waive the privilege or to accept the civil consequences of silence if he or she exercises it. [Citations.]” There is a wide range of civil sanctions that can be imposed on a litigant who asserts his Fifth Amendment right, but the severity of such sanctions generally depends on whether the party invoking the privilege is the plaintiff or the defendant. If the plaintiff in a civil action asserts the privilege and refuses to testify, the court may dismiss the action on the basis that “`[o]ne may not invoke the judicial process to seek confirmation and at the same time use the privileges granted by that process to avoid the development of evidence bearing on his rights to such relief. [Citation.]” [Gunderson v. Wall, B204268 (Cal. App. 11/17/2009) (Cal. App. 2009)]

Some common types of healthcare fraud

• Fraud committed by medical providers

• Double billing: Submit multiple claims for the same service
• Phantom billing: Billing for a service visit or supplies the patient never received
• Division: Send multiple bills for the same service
• Encoding: Billing for a more expensive service than the patient actually received

Fraud judgments in detail

Barry Zalma, Esq., CFE

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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