Guilty of Insurance Fraud
People who commit insurance fraud think it is a crime without punishment or concern. When they are caught, prosecuted and convicted, the perpetrator is so amazed that he or she is one of the few unlucky ones who were caught that they use their ill-gotten
gains to fund unfounded and frivolous appeals.
Peter Costas bribed dozens of people addicted to heroin and other drugs to enter rehab centers so the Red Bank, N.J. man and his cronies could illegally soak up money for lucrative referrals. Costas worked with several marketing firms to recruit potential
patients who had robust private health insurance from New Jersey and elsewhere. Costas paid them up to several thousand dollars each. Costas stayed in touch with the patients at the rehab facilities. He instructed them to stay long enough to generate referral payments. Sometimes he directed patients to different rehab facilities month after month to generate multiple referrals. The facilities paid the marketing firms $5,000-$10,000 per patient referral, and about half went to Costas and other body brokers. Costas received 13 months in federal prison.
Thousands of healthy people plus patients with diseases like Alzheimer’s and dementia were falsely told they had just 6 months to live so they could be enrolled in Medicare hospice for $150 million of fraudulent billing. Rodney Mesquias ran a hospice chain called Merida Health Care group, in Texas. In many cases, people were still walking, driving and even coaching sports when Merida’s marketers told them they were dying. Mesquias even sent chaplains to discuss last rites and prepare people for imminent death — while enrolling them at group homes, nursing homes and housing projects. People were kept in hospice for years — lining the pockets of Mesquias and his conspirators. Sometimes Mesquias had doctors do emergency surgical procedures to keep hospice patients alive and the false bills flowing. Physicians also were paid kickbacks to qualify patients for hospice. Mesquias forged medical records to create the illusion that his patients were dying. He bought luxury cars, jewelry, clothing, real estate, season tickets for the San Antonio Spurs, and bottle service at Las Vegas nightclubs. He treated marketers to parties and tens of thousands of dollars worth of booze. Mesquias was handed 20 years in federal prison.
Read last two issues of ZIFL here https://zalma.com/zalmas-insurance-fraud-letter-2/
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He also serves as an arbitrator or mediator for insurance related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 52 years in the insurance business. He is available at http://www.zalma.com and email@example.com.
Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.
Over the last 53 years Barry Zalma has dedicated his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to make it possible for insurers and their claims staff to become insurance claims professionals.
Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921
Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts
Listen to the Podcast: Zalma on Insurance https://anchor.fm/dashboard/episodes Zalma on Insurance
Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg/
Go to the Insurance Claims Library –https://zalma.com/blog/insurance-claims-library/