Zalma’s Insurance Fraud Letter February 1, 2024

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Zalma’s Insurance Fraud Letter February 1, 2024

ZIFL Volume 28 Issue 3

Barry Zalma

Feb 01, 2024

Transcript

Fraudulently Submitting Fake Applications Violates Licensing Statutes

Insurance Producer Fraudulently Submits Applications to Insurer

Paul B. Kumar appealed a final agency decision of Commissioner of the Department of Banking and Insurance (Commissioner or Department) revoking his insurance producer license and imposing $60,774.25 in civil penalties, surcharge, attorney’s fees and costs of investigation, for violations of the New Jersey Insurance Producer Licensing Act of 2001 and the New Jersey Insurance Fraud Prevention Act (Fraud Act).

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

More McClenny Moseley & Associates Issues

This is ZIFL’s twenty third 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.

12/19/2023

$10,170,665.53 Default Judgment Against MMA (Including Interest)

Read this full article and the entire issue of ZIFL here.Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Now Available The Compact Book of Adjusting Property Claims – Fourth Edition

On January 2, 2024, in Kindle, paperback and hardback formats, The Compact Book of Adjusting Property Claims, Fourth Edition is now available for purchase here.and here. The Fourth Edition contains updates and clarifications from the first three editions plus additional material for the working adjuster and the insurance coverage lawyer.

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Convictions From the Coalition Against Insurance Fraud

Dr. Michael Villarroel, working as a doctor in the US Navy, was sentenced in federal court to one year and one day in custody. Villarroel admitted that from 2012 to at least December 2015, he conspired with other members of the Navy to obtain money from the United States by making claims for life insurance payments based on exaggerated or fake injuries and disabilities. Villarroel certified that he reviewed the records and determined the injuries were legitimate when in fact he knew they were fake or exaggerated. At times, Villarroel falsely stated that he interviewed the claimant and provided other service members with actual medical records to be used in fabricating claims. Villarroel knew the claims were false, but he signed off on them to receive kickbacks once the fake injuries resulted in insurance payouts. In addition to prison time, Villarroel will have to pay $180K as criminal forfeiture.

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Health Insurance Fraud Convictions

Four Plead Guilty to Healthcare Offenses, Including Doctors and Lab Owners

Mark Rubin, 58, Renee Field, 44, Kelly Nelson, 52, and Carlos Hornedo, 61, were all charged via felony informations in December 2023. Mr. Rubin, on January 17th, and Mr. Hornedo, on January 10th, both pleaded guilty to one count of conspiracy to solicit and receive illegal kickbacks. On December 13th, Ms. Field and Ms. Nelson both pleaded guilty to one count of conspiracy to pay and receive health care kickbacks. The defendants each face a maximum penalty of not more than five years in federal prison, a $250,000 fine, and may be ordered to pay restitution.

Read this full article and the entire issue of ZIFL here.Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Lawyer With Unfortunate Name & Advertising Asking that People Should ‘Hire A Dick’ Faces Six Figure Sanctions

Eric B. Dick, Esq, for the second time in three months has been ordered to reimburse an insurer more than $100,000 for filing a “frivolous, groundless” lawsuit made “solely for the purpose of harassment.”

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

New Book Now Available from Barry Zalma

Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition

Property Investigation Checklists: Uncovering Insurance Fraud, 14th 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, extracontractual damages, The fake burglary, and Lawyers Deceiving Insurers, Courts & Their Clients During, Catastrophes—A New Type Of Fraud and the appendices includes the NAIC Insurance Information and Privacy Protection Model Act and usable forms for everyone involved in claims and will provide necessary information to the claims adjuster, SIU fraud investigator, claims manager, or coverage lawyer.

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;

Other Insurance Fraud Convictions

Life Insurance Fraud in South Africa

Onthatile Sebati and her co-accused and cousin Tumelo Mokone with Mokone’s brother Kagiso, were found guilty of killing her parents, sister and brother in 2016.

Sebati, 23, and her two cousins were found guilty in the Pretoria high court of murdering her father, mother, eight months pregnant sister and young brother. Sebati paid her cousins Tumelo and Kagiso Mokone R100,000 from life insurance payouts she received after the murders. She was 15 years old when she came up with the plot to kill her father, police constable Solomon Lucky Sebati, mother Mmatshepo, a nurse at an old-age home, her 19-year-old pregnant sister Tshegofatso and her young brother Quinton at their home at Mmakau near Brits in the North West in December 2016.

Read the full article at https://lnkd.in/gbvHmgGf; read the full issue in pdf at https://lnkd.in/giC2Kg4f;