Zalma’s Insurance Fraud Letter – September 15, 2024
Posted on September 16, 2024 by Barry Zalma
ZIFL Volume 28 Number 18
Read the full article at https://lnkd.in/gtg-zFF2, see the full 18 page pdf at https://lnkd.in/gTy3ziYk, see the full video at https://lnkd.in/gnxQxy4M and at https://lnkd.in/gNcrs22f and at https://zalma.com/blog.
The Source for the Insurance Fraud Professional
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. 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:
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
It is Dangerous for Insurance Fraudster to Ignore Court Orders
Court Orders DOJ to Indict Serial Fraudster for Criminal Contempt
The USDC described Defendant Alberto Marzan as a serial fraudster who has largely managed to dodge accountability for victimizing individuals in the entertainment industry. Plaintiff Michaleen Josephs sued Marzan and his company, Press Media Group (“PMG”), after Marzan fraudulently induced Josephs to issue a series of bogus investments and other payments. When Marzan failed to respond, the Court entered default judgment for Josephs and awarded damages and equitable relief, including a requirement that Marzan divest from his enterprises and provide any future potential investors, employees, or business associates with copies of the Court’s default judgment order and his 2014 guilty plea for insurance fraud.
In Michaleen Josephs v. Alberto Jose Marzan and Press Media Group, Inc., doing business as VumaTV, CIVIL No. 21-749 (JRT/DTS), United States District Court, D. Minnesota (August 22, 2024) found its patience exhausted because Marzan has continued to defraud others using the same businesses and has not complied with the Court’s disclosure orders, all while expressing his knowledge of, and disdain for, the Court’s order.
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
More McClenny Moseley & Associates Issues
This is ZIFL’s thirty 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.
August 6, 2024
PCG Consulting (“PCG”) is being sued by a factoring company, IAG, in New York Federal Court. IAG alleges it was assigned the rights to the claims purchased from PCG by PMC Funding 2021, LLC (“PMC”). We have attached the First Party Claims Non-Recourse Sale and Assignment Agreement between PCG and PMC. This was attached to the lawsuit as Exhibit “A”.
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
LOUISIANA ADVISORY LETTER ABOUT INSURANCE FRAUD
The Louisiana Legislature’s Act 389 broadens the definition of a fraudulent insurance act to include any false or misleading statements, estimates, invoices, bids, proposals, proofs of loss, or any other document presented to an insurer or insured that misrepresents the scope of damages or costs associated with a property insurance claim.
Specifically, the letter, quoted below, indicates that it is wrong for a person selling goods or services to advertise that it will waive the insured’s deductible without the insurer’s consent.
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
Health Insurance Fraud Convictions
7.6 Million from Health Insurer for Using Banned Medicaid Provider
Fidelis Contracted with Social Worker Ward Halverson Despite His Criminal Conviction, License Suspension, and Ban from the Medicaid Program
New York obtained a settlement with Fidelis Care (Fidelis) for causing vulnerable Medicaid patients in Central New York to receive treatment at a company owned by a social worker who had previously lost his license after being convicted of a crime. Fidelis billed Medicaid for services provided by Cornerstone Herkimer, LLC (“Cornerstone”), even though the company’s sole owner and director, Licensed Clinical Social Worker Ward Halverson, had been excluded from the Medicaid Program. Halverson was banned from being a Medicaid provider in 2017 after being convicted of a misdemeanor for firing a BB gun at a child. Under the settlement, Fidelis will pay back more than $7.6 million in reimbursements to the Medicaid program. Fidelis also agreed to perform systematic status checks of those it contracts with against federal and state lists of providers excluded from Medicaid, and terminate any prohibited relationships identified during its reviews.
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
IOWA INSURANCE DIVISION STING
In a recent sting operation conducted by the Iowa Insurance Division, four roofing companies, including Reeves Roofing, were issued cease-and-desist orders for allegedly acting as unlicensed public adjusters. The crackdown follows concerns about roofers negotiating with insurance companies on behalf of homeowners without the proper licensing. According to Iowa law, contractors are prohibited from acting as both contractors and adjusters on the same project, and they must be licensed and trained to negotiate claims with insurers.
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
Convictions of Other Than Health Insurance Fraud
Officer Sentenced for Selling Crash Victim Information to Referral Service for Lawyers
Vincent Forrest, a former patrol officer with the Metropolitan Police Department (MPD) was recently sentenced in U.S. District Court to 20 months in prison for his role in a bribery scheme in which he unlawfully provided non-public police information in exchange for cash payments.
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
Construction of Insurance Contracts for The Insurance Fraud Professional
To adequately investigate a potentially fraudulent claim it is imperative that all involved know how insurance policies are read, understood and interpreted by the courts. The insurance fraud investigator, the claims representative faced with a potentially fraudulent claim and the lawyer called upon to represent an insurer faced with a potentially fraudulent claim who do not understand the interpretation of insurance policies will face unnecessary difficulties and may allow a fraud to succeed.
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
Barry Zalma, Esq., CFE
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455, write to Mr. Zalma at zalma@zalma.com;
http://www.zalma.com;
http://zalma.com/blog.Read this article and the full 18 pages of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
He publishes daily articles at
, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455, write to Mr. Zalma at zalma@zalma.com.
He publishes daily articles at
, Go to the Insurance Claims Library – https://lnkd.in/gKCTg53 to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.
Read full issue here: http://zalma.com/blog/wp-content/uploads/2024/09/ZIFL-09-15-2024.pdf
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