Watch the full video at https://rumble.com/v2b9mt4-zalmas-insurance-fraud-letter-march-1-2023.html and at https://youtu.be/KhITzgBsOsA
Read the full ZIFL text at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
The McClenny Moseley & Associates (MMA) series of lawsuits, court hearings, and insurance department actions have caused some very serious problems for MMA, including court orders, dismissal of lawsuits, administrative cease and desist orders, and litigation, all of which have created a poster child for Zalma’s insurance fraud letter .
Because MMA has admitted that it reported a claim to various insurers, including Allied Insurance, that it made claims against Allied and at least 856 claims to Allied and other insurers, that it represented the insured when in truth it did not. represents the insurer’s insured, but rather Apex Roofing which is not insured with any of the insurers to which MMA has made claims, demanded valuations and settled damages, cashed checks and collected attorneys’ fees from persons it did not represent, the insurer is required to report each claim to Louisiana Department of Insurance as suspected insurance fraud committed or attempted.
Therefore, subject to review by the Louisiana Attorney General and/or local prosecutors, it appears that MMA violated Louisiana’s statute of frauds, and that any insurer victim of one or more of the at least 856 fraudulent claims in which MMA represented it was the attorney for the insurers’ insureds was a criminal fraud.
Because the actions of Velawcity and Apex Roofing appear to meet the definition of a “runner,” Louisiana state prosecutors should consider prosecuting their fraudulent activities.
Additionally, the federal judges involved in these cases should consider reporting MMA, Velawcity and Apex Roofing to the US Attorney for investigation of the potential crime of wire fraud.
There will be more hearings in March 2023 which will be reported in the March 15, 2023 issue of ZIFL.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
To prove “arson for profit”, the insurer must prove the three elements necessary to establish arson plus evidence that the insured breached the condition of misrepresentation, concealment or fraud, and/or that the act was an intentional act to defraud the insurer.
A successful “arson for profit defense” depends on a wide range of evidence, including expert testimony, knowledgeable and persuasive witnesses, and effective counsel to the insurer. If any of the evidence for each element is non-existent, weak or sufficient
rebutted by the insured’s experts and witnesses, the insurer’s “arson for profit defense” is likely to fail.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
A company that administered health care claims stole $18 million of funds intended to pay the claims. Anthony Riccardi began by administering third-party health care claims for a chain of auto dealerships in New Canaan, Connecticut. Employee Benefit Solutions created invoices for the auto dealership brand, which submitted payments and expected the funds to be disbursed to health care providers. EBS stole nearly $18 million of the $26 million the dealer paid. Most of this money was transferred to EBS’s operating account and used for expenses outside the company – mortgages, boats, golf and luxury cars. Riccardi only paid claims from health care providers he thought were likely to complain, or involved the car dealership’s executives. The fraud also included inflated or false medical claims, including some false ones
company under Riccardi’s name. Unpaid financial obligations began to mount, prompting Riccardi to apply for millions in fraudulent bank loans and cash advances. They were used in part to pay financial commitments to the car dealership. To cover up the loan program, Riccardi forged invoices from a bogus company that allegedly sold upgraded billing software to EBS. Ricardi pleaded federally guilty. He faces up to 30 years in prison when convicted and agreed to pay $14.8 million in restitution.
Read the full article plus many more reports on convictions and the entire ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Every insurer, insurance syndicate, insurance broker, insurance sales agency, insurance company branch office and supplier to the insurance industry should add the libraries to their various offices or employees.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Ronald A. Beasley II, 33, of Portsmouth, Florida, was a pharmacist-in-charge at NH Pharma, a pharmacy in Lake Mary, Florida. Through NH Pharma, Beasley and his co-conspirators billed Medicare for expensive compounded drug creams that they never used
actually purchased or dispensed, and instead gave Medicare patients an inexpensive compounded medicated cream not covered by Medicare.
Inventory records showed that NH Pharma did not buy enough expensive prescription drugs to fill all the prescriptions that NH Pharma billed to Medicare. In total, Beasley and his co-conspirators received more than $1 million in fraudulent Medicare proceeds.
A federal jury in the Middle District of Florida convicted Beasley, a Virginia man on February 9, 2023 for his role in a scheme to defraud Medicare of more than $1 million in prescription drug benefits.
Beasley was convicted of conspiracy to commit health care fraud and three counts of health care fraud. He is scheduled to be sentenced on April 25 and faces a maximum sentence of 10 years in prison on each count. A federal district judge will determine each sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Read the full article including more than a dozen convictions and the entire ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
The story that follows is a fictionalized True Crime Story about insurance fraud from my 55 years in insurance that explains why insurance fraud is a “Heads I Win, Tails You Lose” situation for insurance companies. This is one of more than 80 stories in my book “Insurance Fraud Costs Everyone” Available as Kindle Book and Available as Paperback from Amazon.com.
In 1990, Moshe Ben-Cohain and Menashe Ben-Cohain engaged in behavior that led to their arrest for insurance fraud. They failed to appear after posting bail and, along with their co-conspirator, Raz Rosenberg, are on the run.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Herbert Allen, age 38, and Dion Ridley, age 23, pleaded guilty to Conspiracy to Commit Mail Fraud in violation of Title 18, United States Code, Section 371. Allen was sentenced to 37 months in prison, followed by 3 years of supervised release, and Ridley was sentenced to 6 months in prison, followed by 1 year of supervised release.
The defendants admitted to a conspiracy to commit mail fraud in connection with a staged car crash. In the scheme, Allen falsely claimed to be the driver of a car that was hit by a tractor-trailer on June 28, 2017. Ridley, a passenger in the car, falsely claimed that Allen was driving the car and they were hit by a tractor-trailer.
In fact, the government’s evidence showed that the defendants conspired with Damien Labeaud, Roderick Hickman and others to intentionally crash Allen’s 2007 Chevrolet Impala into a tractor-trailer in the area of Tchoupitoulas Street and Calliope Street in New Orleans.
Read the full article and about many more insurance fraud convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
(c) 2023 Barry Zalma & ClaimSchool, Inc.
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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 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
Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; daily articles are published on 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 Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to Insurance Claims Library – https://zalma.com/blog/insurance-claims-library
