Zalma’s Insurance Fraud Letter – January 2, 2025
Post 4963
See the full video at https://rumble.com/v64l0qy-zalmas-insurance-fraud-letter-january-2-2025.html and at https://youtu.be/DbVMoZoETMc
Zalma’s Insurance Fraud Letter (ZIFL) starts its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ This issue contains the following articles about insurance fraud:
Covid Delay of Trial Appropriate
No Right to Trial if Defendant Waives Right to Speedy Trial by Defendant
On February 12, 2020, the State charged Franklin Lee Boger with one count of Level 2 felony arson resulting in serious bodily injury, four counts of Level 4 felony arson, one count of Level 6 felony arson, and one count of Level 5 felony insurance fraud. Boger’s trial was set for a certain date, continued with the agreement of Boger several times and without his agreement several times. He appealed in Franklin Lee Boger v. State of Indiana, No. 24A-CR-1003, Court of Appeals of Indiana (December 5, 2024) seeking dismissal of the charges because of the delays.
Read the full article and all 25 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-01-01-2025.pdf
Doctor Convicted of Healthcare Fraud & Tax Fraud
In United States Of America v. William Weiner, No. 22 Cr. 19 (PGG), United States District Court, S.D. New York (December 18, 2024) Defendant William Weiner pled guilty to conspiracy to commit healthcare fraud and tax fraud. On September 19, 2024, the USDC sentenced Weiner to time-served and two years’ supervised release but deferred its determination as to restitution. The Government now seeks an order directing Weiner to make restitution to (1) Farmers Insurance Exchange in the amount of $334,612.22; and (2) the Internal Revenue Service (“IRS”) in the amount of $76,127.00.
Read the full article and all 25 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-01-01-2025.pdf
MORE MCCLENNY MOSELEY & ASSOCIATES ISSUES
This is ZIFL’s fortieth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges believe may be attempts to criminally profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
Read the full article and all 25 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-01-01-2025.pdf
Ex-Police Officer Guilty of Fraud & Other Crimes
Convictions for Multiple Crimes and Insurance Fraud Affirmed
Von Harris (“Harris”), an ex-police officer, appealed his conviction and sentence following a jury trial. In State Of Ohio v. Von Harris, 2024-Ohio-5808, No. 113618, Court of Appeals of Ohio (December 12, 2024) he claimed multiple errors at trial, almost all of which were affirmed by the Court of Appeals.
Read the full article and all 25 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-01-01-2025.pdf
ATTEMPTS TO COMPEL ETHICAL BEHAVIOR WHILE ATTEMPT TO DEFEAT FRAUD
Some states have attempted to compel insurers to act ethically and in good faith because of a perception that insurers were deceiving those insured. For example, the California Insurance Code contains a Fair Claims Practices statute (California Insurance Code § 790.03) that sets out multiple acts that the Legislature considers unethical and an unfair claims practice.
Read the full article and all 25 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-01-01-2025.pdf
HEALTH INSURANCE FRAUD CONVICTIONS
Southern California-Based Clinics, Laboratory and Their Owners to Pay $10M for False Claims Arising from Kickbacks and Self-Referrals
Mohammad Rasekhi M.D., Sheila Busheri, Southern California Medical Center (SCMC) and R & B Medical Group Inc., doing business as Universal Diagnostic Laboratories (UDL) (collectively, the defendants), have agreed to pay $10 million to resolve allegations that they submitted false claims to Medicare and California’s Medicaid program, known as Medi-Cal, arising from allegations of paying kickbacks and making self-referrals. The defendants are all based in southern California. Rasekhi is the founder and chief medical officer of SCMC and the co-owner of UDL. Busheri is the chief executive officer of SCMC and the co-owner and chief executive officer of UDL. SCMC is a federally qualified health center that operates six clinics in southern California. UDL is a reference and esoteric laboratory in Southern California.
Read the full article and reports on dozens of convictions and all 25 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-01-01-2025.pdf
CONVICTIONS OF OTHER THAN HEALTH INSURANCE FRAUD
Iowa Contractor Agrees to Consent Order Over Unlicensed Public Adjusting
Central Iowa Gutter and Donald Smart agreed to make changes to stop holding themselves out as public adjusters or providing any public adjuster services on its websites, social media pages, and advertisements.
Read the full article and all 25 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-01-01-2025.pdf
The Start of the Tort of Bad Faith
Critz v. Farmers Insurance Group
In Critz v. Farmers Insurance Group, 230 Cal. App. 2d 788, 41 Cal. Rptr. 401 (Cal.App.Dist.3 11/18/1964), Plaintiff Betty Critz was a passenger in an automobile driven by her husband. They were involved in a collision with an automobile driven by David Arnold. Arnold lost control of his vehicle while trying to negotiate a curve; his automobile crossed over to the opposite side of the road and crashed head-on into the Critz car. Mrs. Critz received numerous injuries, including the loss of sight in one eye and fractures of the neck and jaw. Arnold had liability insurance issued by defendant Farmers Insurance Group, with a coverage limit of $10,000 for injuries to one person.
Read the full article and all 25 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-01-01-2025.pdf
BARRY ZALMA
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Write to Mr. Zalma at zalma@zalma.com; https://www.zalma.com; https://zalma.com/blog.
Go to Zalma’s Insurance Fraud Letter at https://zalma.com/zalmas-insurance-fraud-letter-2/; Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ and GTTR at https://gettr.com/@zalma
Like this:
Loading…
