Zalma’s Insurance Fraud Letter – October 15, 2023
This, the twentieth issue of the 27th year of publication Zalma’s Insurance Fraud Letter provides multiple articles on how to deal with insurance fraud in the United States.
See the full video at https://rumble.com/v3paf40-zalmas-insurance-fraud-letter-october-15-2023.html and at https://youtu.be/oMfGmFE0OIg
Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
Don’t Ty to Defraud GEICO It Bites Back
GEICO (collectively, “GEICO” or “Plaintiffs”) sued Defendants ALP Supply, Inc. (“ALP”), PV Supply, Inc. (“PV”), and Pal Vakula, alleging common law fraud and unjust enrichment claims.
Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
McClenny Moseley & Associates Issues
This is ZIFL’s sixteenth 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 indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
Evidence Required to Prove Fraud
Insurer Not Required to Disclose How it Selects Limits and Premium
Ira Trocki sued Pennsylvania National Mutual Casualty Insurance Company (“Penn National”) for fraud related to certain insurance policies. The District Court granted summary judgment for Penn National.
In Ira Trocki, trading as Jack Trocki Development, LLC v. Penn National Mutual Casualty Insurance Company, No. 22-1483, United States Court of Appeals, Third Circuit (September 13, 2023) the Third Circuit explained what is needed to prove fraud.
Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
Good News From The
Nerik Ilyayev and Mukhiddin Kadirov have pleaded guilty for multiple cases of insurance fraud. The pair of fraudsters admitted to HIV medication fraud, no-fault automobile insurance fraud, and money laundering schemes totaling over $6M. Ilyayev pled guilty to conspiracy to commit healthcare fraud for using two different pharmacies to defraud Medicare and Medicaid in connection with HIV medication claims and to defraud no-fault automobile insurance providers in connection with other medication claims. Meanwhile, Kadirov laundered several million dollars in fraud proceeds in connection with the HIV fraud scheme. This happened from approximately February 2021 through March 2022. In order to conceal his role in the fraud scheme, Ilyayev stole the identity of another person and pretended to be them to own and operate the Pharmacy. In total, Medicare and Medicaid collectively paid approximately $5.2M in fraudulent claims for HIV medications. He would then close his pharmacy and open another, stealing another’s identity to keep the fraud going. The pair face at least 10 years in prison each, with sentences pending.
Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
Not Wise to Explain Scheme to Defraud to FBI Informants
Insurance Fraudster Tries Multiple Bases for Appeal & Still Goes to Jail
Brian Higgins diverted for personal use funds he received from his mortgage servicer to repair damage to his home caused by a broken fish tank. He also filed a lawsuit against two witnesses for the prosecution, accusing them of misdirecting the funds instead of himself. For his conduct, a jury convicted Higgins on three counts of mail fraud under 18 U.S.C. §§ 1341-42 and two counts of retaliating against a witness, victim, or an informant under 18 U.S.C. § 1513(e). He appealed.
In United States of America v. Brian Higgins, No. 22-3538, United States Court of Appeals, Sixth Circuit (October 6, 2023) affirmed his conviction but gave him a win by requiring the District Court to reconsider the amount of restitution he must pay.
Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
California Conference of Arson Investigators Training Seminar
As One of the Speakers, I encourage you to SIGN UP TODAY FOR THE OCTOBER 16 – 19, 2023 CCAI Fire Investigation Training Seminar – where you can learn How Insurers and Arson Investigators Have Taken the Profit from Arson-for-Profit from Attorney Barry Zalma, Esq.
Register today by calling 909 865-5004 Or click here to register online.
Read the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
Health Insurance Fraud Convictions
Husband And Wife Sent to Prison For $8M Health Care Fraud
Vincent Nwabeke, 72, pleaded guilty April 20, 2023, to false statements in a health care matter, while Victoria Nwabeke, 70, admitted to conspiracy to commit health care fraud September. 16, 2019.
Read the about dozens of convictions at this part of the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
Other Insurance Fraud Convictions
Newtown Man Ordered to Pay Restitution for Fraudulent Practices
John Paul Reis, 56, of Newtown Township, Pennsylvania entered an open guilty plea in March to insurance fraud, deceptive business practices, forgery, and theft by deception, all third-degree felonies. He was sentenced for committing fraudulent business practices as the owner of a Bucks County collision center and ordered to pay more than $435,000 in restitution to five insurance companies.
Read the about dozens of convictions at this part of the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2023/10/ZIFL-10-15-2023.pdf
Property Investigation Checklists Uncovering Insurance Fraud, 13th Edition
Author:Barry Zalma
“Property Insurance Checklists, 13th Edition” Now Available from Thomson Reuters a New Book From Barry Zalma
Read the full article at https://www.linkedin.com/pulse/new-property-insurance-checklists-13th-edition-barry-zalma-esq-cfe and at https://zalma.com/blog . Property Investigation Checklists: Uncovering Insurance Fraud 13th Edition provides detailed guidance and practical information on the four primary areas of any investigation of suspicious claims.
The book also examines recent developments in areas such as arson investigation procedures, bad faith, and extracontractual damages. The appendix includes the NAIC Insurance Information and Privacy Protection Model Act, forms useful to investigators, and the full text of how thorough investigation defeated a fraudulent claim and convicted a lawyer to a long term in prison.
Available at https://store.legal.thomsonreuters.com/law-products/Forms/Property-Investigation-Checklists-Uncovering-Insurance-Fraud-13th/p/106702361 and as a THOMSON REUTERS PROVIEW eBOOK EDITION https://store.legal.thomsonreuters.com/law-products/Forms/Property-Investigation-Checklists-Uncovering-Insurance-Fraud-13th/p/106702363
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About Barry Zalma
An insurance coverage and claims handling author, consultant and expert witness with more than 48 years of practical and court room experience.
