Zalma's Insurance Fraud Letter - April 1, 2024
ZIFL-04-01-2024 Volume 28, Number 7
Read the full article at https://lnkd.in/gvKdq6Qc and at https://zalma.com/blog and the full article in pdf at https://lnkd.in/gBj_3yVw plus more than 4750 posts.
Post 4766
Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th 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.
This month's issue contains multiple articles for the insurance fraud professional and the insurance claims professional. The current issue can be read in full at https://lnkd.in/gBj_3yVw and includes the following articles:
Prison Employee Commits a Crime She Was Employed to Prevent
GUILTY OF WORKERS’ COMPENSATION FRAUD
On January 10, 2022, defendant Tiffinie Marvell Jones was convicted by a jury of one count of insurance fraud. Jones filed a motion for a new trial, which was denied. On appeal, Jones argued that there was insufficient evidence to support the verdict, that her trial counsel provided ineffective assistance, and that the trial court abused its discretion when it denied her motion for a new trial.
In The People v. Tiffinie Marvell Jones, F085205, California Court of Appeals, Fifth District (March 14, 2024) the Court of Appeals affirmed her conviction.
Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf.
More McClenny Moseley & Associates Issues
This is ZIFL’s twenty fifth 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.
From the Coalition Against Insurance Fraud
The Top 5 Covid-19 Scams
1 Fake "corona" insurance
2 Cancelled health insurance
3 corona medicines, tests
4 Senior Scams
5 Bogus Travel Insurance
Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf.
Health Insurance Fraud Convictions
Physician Pays $95,000 to Resolve Allegations of Genetic Testing Fraud
Nishi Patel, MD, a physician who received his medical training at Drexel University, will pay $95,000 to resolve allegations that he violated the False Claims Act by ordering medically unnecessary genetic testing for Medicare beneficiaries.
Read the full article including dozens of convictions and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf.
New Book Now Available from Barry Zalma
Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition, the newest book joins other insurance, insurance claims, insurance fraud, and insurance law books by Barry Zalma all available at the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/
Other Insurance Fraud Convictions
Public Insurance Adjuster Sentenced to Three Years in Prison After Stealing $108k From Homeowners,
Stephen E. Chastain, 62, represented a Gwinnett County couple as their insurance adjustor after their house burned in 2019, according to the Gwinnett County district attorney. According to the district attorney, it was stipulated that Chastain would take 15% of the settlement as his fee. The district attorney said the company “did very little work, and the victims never saw the entirety of their insurance settlement.”
Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf.
SOFT FRAUD
How Most Get Away With Insurance Fraud
For reasons known only to governmental entities some insist on categorizing fraud into both “hard” and “soft” fraud. By so doing the governmental entities that so categorize fraud make one type of fraud less heinous and less criminal than the other. Fraud, whether categorized “soft” or “hard,” are criminal and if a person is tried and convicted of fraud both can be sent to jail for the same amount of time.
The types of insurance fraud some call “soft fraud” are found in every type of claim presented to an insurer.
Soft fraud, which is sometimes called opportunity fraud, occurs when a policyholder or claimant exaggerates a legitimate claim.... According to the Insurance Research Council, soft fraud is far more frequent than hard fraud. Because of the frequency of soft fraud, it adds more to overall claims cost than hard fraud does.
Soft fraud occurs when a policyholder exaggerates an otherwise legitimate claim or when an individual applies for an insurance policy and lies about certain conditions or circumstances to lower the policy’s premium.
Adapted from my Book, “Insurance Fraud – Second Edition” Available as a Kindle book; Available as a Hardcover; Available as a Paperback
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Adapted from my Book, “Insurance Fraud – Second Edition” Available at amazon.com.
Read the full article and the full issue of ZIFL at https://lnkd.in/gBj_3yVw.