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The full issue in Adobe .pdf format is available here.
Below are summaries of some of the articles in the current issue.
Prosecutors also indicted three former Allianz employees, two of whom agreed to plead guilty.
One of Alliance SEs ALIZF Investment firms pleaded guilty to securities fraud and agreed to pay approximately $ 6 billion in penalties and repayments to investors who suffered losses when some of the subsidiary’s hedge funds fell during market sales in March 2020.
Florida proposes amendments to reduce fraud
Florida lawmakers are concerned about property insurance for state citizens and intend to work to defeat or deter fraud and abuse through the insured’s grant of benefits (AOB) to public insurance adjusters, roofer, contractors or attorneys. Florida CFO Jimmy Patronis is leading the work. Patronis spoke with Florida Citizens Property Insurance Corporation’s CEO Barry Gilway and outlined five key areas for reforming Florida’s property insurance market.
Judges in North Carolina order Lindberg to relinquish control of companies to reimburse insurance companies
Wake County Superior Court Judge Graham Shirley ruled that Lindberg intended to defraud the carriers after signing the agreement to stabilize them in 2019.
When he issued the order, Shirley said that he executed the agreement that Lindberg signed when they were put under rehabilitation. Greg Lindberg was ordered to relinquish control of hundreds of his companies in a plan to rescue four of his insurance companies.
Good news from The Coalition Against Insurance Fraud
Fraudsters tricked tens of thousands of patients into getting their insurance companies billed for more than $ 900 million of unnecessary and overpriced compound pain and scarring in a telemedicine system. Synergy Pharmacy (Palm Harbor, Florida) hired a telemarketing company called HealthRight to call consumers, trick them into accepting drugs and handing over their insurance information. HealthRight then bribed doctors to approve the scripts via its telemarketing platform – even though the doctors never met or examined the patients. The documents relied solely on HealthRight’s fake patient screening to approve the fake scripts. HealthRight generated at least 60,000 scripts, deceived honest pharmacy managers by mislabeling the medications and hiding allegations of cheating insurers to pay for the script. Telemed systems are spreading around the United States. Arm length technology has inspired some of the largest insurance systems in the last five years. Several tried to erode health insurance companies with more than $ 1 billion in false claims each. Seven fraudsters were convicted federally in Greenville, Tennessee in the latest insurance conspiracy.
Health insurance fraud
Sarasota pain doctor and former Insys salesman convicted of fraud in healthcare
Dr. Steven Chun (59, Sarasota) and Daniel Tondre (52, Tampa) was convicted by a federal jury. Both were found guilty of conspiring to pay and receive bribes, in the form of speaking fees, in exchange for printing the fentanyl spray Subsys. The two were also convicted of five different cases of having paid and received returns on specific dates. Tondre was also convicted of two counts of identification fraud in connection with the sham speaker incidents. Each risks a maximum sentence of 5 years in federal prison for conspiracy, and up to 10 years in prison for each material offense. Tondre also risks up to 5 years in prison for each identification fraud. The United States requires a monetary judgment in the amount of the proceeds of the returns. No date for the verdict has yet been set.
The NICB reports that fraudulent disaster claims cost additional non-life insurance companies $ 4.6 billion to $ 9.2 billion
The National Insurance Crime Bureau (NICB) has done some analytical work to quantify the impact of one of the most relevant inflation factors for disaster and severe weather requirements, particularly relevant to the ILS and reinsurance market, fraudulent claims.
Other convictions for insurance fraud
Guilty of fake car theft
John Michael Fletcher, 61, was convicted of false reporting and filing a false insurance claim. Fletcher, a man from Knoxville, was convicted of incorrectly telling police that his car had been stolen before attempting to obtain insurance compensation for more than the value of the vehicle.
On December 7, 2018, Fletcher asked an employee to move his H3 Hummer motor vehicle. He then told Knoxville Police and his insurance company that the Lobster had been stolen. Bright and Roberts explained that Fletcher claimed that he had bought the vehicle for almost double what he actually paid for it.
Nearby surveillance video showed the vehicle being moved, and once the vehicle was found, there were no signs of intrusion or damage to the ignition indicating that it had been stolen. At the verdict, prosecutors expect to receive a reinforced sentence because Fletcher reportedly threatened the insurance agent when they did not pay the claim. Fletcher also has a previous conviction for second-degree murder from Washington County, Tennessee.
False reports and filing a false insurance claim are both Class D offenses with a penalty of between two and four years. The verdict in this case will take place on July 16.
New book: Ethics for The Insurance Professional, third edition
Available as Kindle block. Available as a pocket. Available as hardcover.
True crime stories about insurance fraud
More than 81Video True Crime Stories on insurance fraud are now available at https://rumble.com/zalma.
New books now available on Amazon.com: Insurance fraudsters do not earn a quarter
New book that explains how to defeat or discourage insurance fraud
What every insurer should know about how it can be proactive in working against insurance fraud by refusing to pay any fraudulent claim.
Available as a pocket here. Available as hardcover here. Available as a Kindle book here.
California Fair Claims Settlement Practices Regulations 2022
Every California claimant must read, understand, or be trained in the California Fair Claims Settlement Practices Regulations by September 1 of each year.
Available as a Kindle book. Available as paper back
(c) 2022 Barry Zalma & ClaimSchool, Inc.
Barry Zalma, Esq., CFE, now limits his internship to the position of insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. 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. He is available at http://www.zalma.com and firstname.lastname@example.org.
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