قالب وردپرس درنا توس
Home / Insurance / Zalma’s Insurance Fraud Letter – September 1, 2022

Zalma’s Insurance Fraud Letter – September 1, 2022



The issue, available as a 25 page .pdf document here ZIFL-09-01-2022

Watch the full video at https://rumble.com/v1i44c7-zalmas-insurance-fraud-letter-september-1-2022.html and at https://youtu.be/75WWxAt2UU0

The issue contains articles including:

Andrew Joseph Mitchell, according to to the Texas Department of Insurance, which reported that a public adjustment company sanctioned last month by Louisiana regulators has pocketed more than $300,000 in insurance payouts intended for Texas property owners.

Plaintiff appealed the district court’s order granting summary disposition in favor of defendants Home-Owners Insurance Company (“Home-Owners”), American Country Insurance Company (ACIC), and Hartford Accident and Indemnity Company (“Hartford”), with respect to Plaintiff’s claims on uninsured or underinsured motorist benefits and first party personal protection insurance (PIP) benefits under the No-fault Act, MCL 500.3101 a seq. Although the defendants disputed their priority in paying PIP benefits, the trial court did not decide the issue of priority, but instead dismissed all claims based on the anti-fraud provisions of the defendants’ respective policies.

IN Jonathan Jones v. Home-Owners Insurance Company, American Country Insurance Company, And Hartford Accident & Indemnity Company and Sharneta Hendersonno. 355118, Court of Appeals of Michigan (August 18, 2022), the Court of Appeals issued a Solomon-like decision.

Oneatha SwintonThe former acting principal of Port Richmond High School in Staten Island, New York, convicted of auto insurance fraud kept her job with the New York Department of Education — and even got a raise — despite what school investigators called her “pattern of dishonesty.”

The DOE gave Swinton a deal to stay despite the felony conviction plus the finding that she improperly sent $100,000 in school funds to a vendor and “failed to protect” 600 DOE computers, printers and laptops that disappeared under her watch.

Fair Claims Settlement Practices Regulations 2022

If you have not complied by today, you are in violation

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 1 of each year and be prepared to swear under oath that the regulation has been followed by insurers.

Grounds for dismissal

The primary grounds for rescission are:

  1. misrepresentation or material fact(s);
  2. concealment of material fact(s),
  3. mistake of material fact(s),
  4. error of law, or
  5. fraud.

Telemedicine fraud.

“Telehealth Fraud, often referred to as Telehealth Fraud, is a growing trend in Medicare. The Covid-19 pandemic created unprecedented challenges for accessing health care for patients in need of social isolation, leading to an explosion in telehealth,” said Maria Alvarez, executive director of StateWide as she announced the Medicare Fraud of the Month.

The government fraud of the month is part of Senior Medical Patrol, the definitive resource for New York seniors and caregivers to help detect, prevent and report Medicare fraud and waste. StateWide is the New York recipient/administrator of this federal program.

Ricky Gonzales ran Ricky’s Construction Company, which supplied construction labor to contractors. The Tampa, Florida man lied about paying workers’ compensation for the workers he provided — who were undocumented immigrants. The contractors then sent Gonzales what they thought were paychecks. Gonzales cashed the checks at banks to pay the workers. Gonzales lied about employees having full job skills. In truth, he accepted and cashed more than $7 million in checks from construction contractors for his employees. That far exceeded the limited payroll that Gonzales reported to his insurer. His employees thus worked in workplaces without sufficient insurance coverage. Insurance companies lost premiums they would have charged had they known the true number of workers their policies were rigged to cover. Gonzalez also illegally evaded state and federal payroll taxes. He pleaded guilty federally and faces up to 25 years in prison when sentenced.

And many more convictions.

South Bay Chiropractor Sentenced to Prison for Taking Kickbacks

A Redondo Beach chiropractor was sentenced to 14 months in prison for soliciting kickbacks from other hospitals. (Shutterstock)

Brian Carrico68, of Redondo Beach, was sentenced on Aug. 26, 2022, to 14 months in federal prison by U.S. District Judge Josephine L. Staton, who also ordered him to pay a $25,000 fine.

The South Bay chiropractor was convicted of taking kickbacks from Pacific Hospital — a Long Beach medical center whose then-owner was later jailed — and soliciting kickbacks from another Southern California hospital. Carrico pleaded guilty in February to one count of soliciting money — the same day his two Redondo Beach-based businesses, Performance Medical & Rehab Center Inc. and One Accord Management Inc. — each pleaded guilty to one count of conspiracy to solicit kickbacks.

And dozens more convictions.

Excellent in damage management

Create a staff of professional claims handlers

Click here to subscribe to excellence in claims management software for each of your claims professionals for only $5 per month or $50 per year by subscribing to Zalma on insurance with locals.

In an effort to save the few remaining insurance companies doing business in Florida, the state has taken aim at unlicensed contractors who some claim have been driving up the cost of repairing Florida properties.

Head of staffing agency in Florida sentenced to 24 years for off-book work schedule

Mykhaylo Chugay from 2007 to 2021, according to federal prosecutors, ran a number of shady staffing companies in South Florida that avoided paying more than $25 million in federal taxes. Last week, a federal judge sentenced Chugay to 24 years in prison for his June conviction for crimes that included wire fraud, harboring illegal aliens and money laundering, according to prosecutors and news reports. Plus many more convictions.

On 25 August 2020, the Association of British Insurers and the Insurance Fraud Bureau announced:

  • The number and cost of fraudulent claims fell in 2021, but the average scam detected was at a record high of over £12,000.
  • Traffic insurance claims fraud is still the most common insurance con.

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;

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




Source link