ZIFL Volume 30, Issue 15
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THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Zalma’s Insurance Fraud Letter (ZIFL) continues its 30th 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 fraud:
Swoop & Squat Fails
The Only Solution to Fraud is to Take the Profit Out of the Crime
It Takes Courage to Fight the Fraudster
In Vivian Maritza Triana Marin, Sebastian Arroyave Penagos, and Daniel Arroyave Penagos v. Marc J. Paynter and Transport Marc Paynter Inc., No. 23-CV-6498, United States District Court, E.D. New York (July 10, 2026) Plaintiffs sued Defendants in diversity after a rear-end collision on the Whitestone Expressway in Queens, New York. Plaintiffs were in a Subaru driven by Vivian Maritza Triana Marin, while Defendant Marc J. Paynter drove a Transport Marc Paynter Inc. tractor-trailer.
Read the full article and all 28 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
Commit Fraud and Suffer Consequences
Victims of Fraud Should Always Fight Back Proactively
Cross-Claim Against Fraudsters Successful
In Dual Diagnosis Treatment Center, Inc., et al. v. Health Net, Inc., et al., Health Net Life Insurance Company, B331260, California Court of Appeals, Second District, Third Division (July 16, 2026) a trial verdict in favor of Health Net and against Sovereign, a network of mental health and substance use disorder treatment centers, and Health Net, Inc., Health Net of California, Inc., Health Net Life Insurance Company, and Managed Health Network, Inc. (collectively, Health Net) was appealed to the California Court of Appeals.
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
More McClenny Moseley & Associates Issues
This is ZIFL’s forty-seventh 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. This is truly becoming a never-ending story.
Texas-based MMA Law Firm PLLC moved to protect owner and attorney John Zachary Moseley from a litigation funder suit during the firm’s bankruptcy.
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
Trouble at Lloyd’s
According to Claims Magazine, Lloyd’s corporate offices have stated that former CEO John Neal breached its compliance rules after failing to disclose a close relationship that could have been perceived as creating a potential conflict of interest.
The Lloyd’s investigation found that Neal failed to disclose the relationship with the group’s former corporate affairs director Rebekah Clement even after concerns were raised by colleagues, according to a statement Wednesday. The investigation conducted on behalf of the council responsible for the management and supervision of Lloyd’s also concluded that Neil failed to ensure that whistleblowing reports had been properly handled in line with his responsibilities as CEO.
Read the full article and all 28 pages of ZIFL at http://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
The Great Jewel Theft
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.
The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
Health Insurance Fraud Convictions
EyePoint Pharmaceuticals to Pay $4.6 Million to Resolve False Claims Act Allegations
Eyepoint Pharmaceuticals, Inc., (EyePoint) headquartered in Massachusetts, has agreed to pay the United States $ 4,657,463.18 to resolve allegations that it violated the False Claims Act by paying kickbacks to certain Ambulatory Service Centers (ASCs) to induce those ASCs to purchase and dispense DEXYCU, an injectable drug approved for the treatment of ocular inflammation following cataract surgery, between January 1, 2019 and March 1, 2023.
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
The Real Cost of Fraud
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime. The names and places of this true crime story were changed to protect the guilty.
After twelve months trying to get insurance on over $3,000,000 in jewelry and a like amount of fine arts, a Taiwanese man who was a wanted criminal in his own country convinced two American insurers to agree to insure him against the risk of loss to the contents of his home.
His application gave the impression that he was a Beverly Hills investor with appropriate concerns for security. He also made it clear that he was willing to pay a high premium for the protection, a fact that should have raised the concern of the underwriters asked to accept the risk of loss of his property.
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
New Jersey Consumer Fraud Act Now Covers Insurance Brokers, Agents, and Producers
On July 15, 2026, the New Jersey Supreme Court issued a decision overturning lower court rulings that had shielded “semi-professionals” — including insurance brokers, agents, and producers, among others — from regulation and litigation under the New Jersey Consumer Fraud Act (NJCFA).
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
Insurer Proactively Works to Defeat Fraud
RICO and PIP Fraud Not Subject to Arbitration in New Jersey
The Only Way to Defeat Fraud is to Eliminate the Fraudster’s Profit
In Allstate New Jersey Insurance Company, et al v. Carteret Comprehensive Medical Care, PC, d/b/a Monroe Comprehensive Medical Care, d/b/a Comprehensive Medical Care, d/b/a Fassst Sport, d/b/a Comprehensive Vein Care, Inimeg Management Company, Inc., et. al. Nos. A-74-24, A-75-24, A-76-24, No. 090337, Supreme Court of New Jersey (July 21, 2026) the Supreme Court considered whether claims of insurance fraud under the Insurance Fraud Prevention Act (the Fraud Act) and the New Jersey Anti-Racketeering Act (RICO) are subject to arbitration under the Automobile Insurance Cost Reduction Act (AICRA).
Other Than Health Insurance Fraud Case
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
Nevada Businesswoman Sentenced to Prison for Fraudulent Scheme Seeking Millions in COVID-19 Tax Credits
Caused a Loss to the United States Exceeding $7 Million
Adonia Stiles, of Las Vegas, was a real estate agent, tax preparer, and clothing store owner. Stiles conspired with others to file false tax returns fraudulently seeking refunds based on the employee retention credit (ERC) and sick and family leave credit. Congress created both the ERC and the sick and family leave credit to aid struggling businesses during the COVID-19 global pandemic. Stiles a Nevada woman was sentenced to 18 months in prison for conspiring to defraud the United States by filing false COVID-19 employment tax credits. The government recommended a sentence of 40 months’ imprisonment.
Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
Barry Zalma
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. 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.
zalma@zalma.com, http://www.zalma.com, http://zalma.com/blog
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Read the full article and all 28 pages of ZIFL athttp://zalma.com/blog/wp-content/uploads/2026/07/ZIFL-08-01-2026.pdf
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