Zalma’s Insurance Fraud Letter – March 1, 2024

ZIFL Volume 28, Issue 5, March 1, 2024

Post 4746

The Source for the Insurance Fraud Professional

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See the full video at https://rumble.com/v4gfkju-zalmas-insurance-fraud-letter-march-1-2024.html  and at https://youtu.be/m39eoeVlGcY

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/

The current issue can be read in full at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf and includes the following articles:

Bloods Gang Member Guilty of RICO to Defraud Insurers

Gangs Took Over Fire Reconstruction Industry in New York

Insurance Fraud is a Violent Crime

Jatiek Smith (also known as “Tiek”) a member of the Bloods Gang was charged with one count of racketeering conspiracy, in violation of 18 U.S.C. § 1962(d), and one count of extortion conspiracy, in violation of 18 U.S.C. § 1951, arising out of allegations that Smith and his co-conspirators engaged in a pattern of extortionate conduct to dominate the fire restoration industry. Smith’s case was tried in a ten-day bench trial between November 27, 2023, and December 11, 2023.

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

More McClenny Moseley & Associates Issues

This is ZIFL’s twenty fourth 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.

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

A New Book: “Once Upon A Claim”

From my friend Chantel M. Roberts whose site lists all her books, and a new author, George Jack – from the Insurance Academy.

https://www.tiltingatwindmillspress.com/ and whose blog you can read at: https://www.tiltingatwindmillspress.com/post/unlocking-insurance-wisdom-with-illustrated-fairy-tales-once-upon-a-claim where she explains the illustrations.

Picture this: classic fairy tales, nursery rhymes, and fables brought to life with whimsical illustrations and sprinkled with valuable lessons about insurance concepts and claims processes. It may sound like a magical dream, but it’s a reality with the upcoming book, Once Upon A Claim: Fairy Tales to Protect Your Ass(ets).

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

Go To Jail, Do Not Pass Go, Stay in Jail

Insurance Agent Defrauded Clients by Keeping Premium for His Own Benefit

In United States Of America v. John M. Thomas, a.k.a. John Thomas, No. 23-11137, United States Court of Appeals, Eleventh Circuit (February 20, 2024) Thomas appealed from his 168-month sentence for 16 counts of wire fraud, 4 counts of money laundering, and 4 counts of money laundering to conceal proceeds of unlawful activity.

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

Barratry

Use of cappers or runners to sign up clients for lawyers is a form of barratry and a type of fraud. Barratry is a very dirty word in the legal profession. Barratry is the vexatious incitement to litigation, typically by soliciting potential legal clients. Stated otherwise, barratry occurs when a lawyer or someone acting on a lawyer’s behalf improperly solicits someone to be a plaintiff in a lawsuit. Think ambulance chasing.

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

From the Coalition Against Insurance Fraud

Enfield woman sentenced for larceny in Medicaid case. Marcy L. Taliceo, from Enfield, pleaded guilty this week in Hartford Superior Court to one count of Larceny related to Medicare fraud. Between 2016 and 2020, Taliceo was billing the state Medicaid program for services done by unlicensed personnel and services that were never provided. Taliceo was President, Treasurer and Secretary of Growing Potential Services, a Connecticut Medical Assistance Program (CMAP) provider that was enrolled as a Behavioral Health Clinician Group. Taliceo was in charge of all aspects of the business, including what services were billed. Growing Potential was paid by the Connecticut Medicaid Program for psychotherapy services by unlicensed individuals in the amount of almost $142K. In addition, Growing Potential was paid a total of nearly $7K for these services. Taliceo was sentenced to four years in prison, execution suspended, with five years of probation. In addition, restitution for the stolen amount must be paid back in full.

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

Health Insurance Fraud Convictions

Holy Health Care Services, LLC Program Administrator Sentenced to Five Years in Federal Prison for a Health Care Fraud

Lambert Mbom, age 50, of Riverdale, Maryland, was sentenced by U.S. District Judge Paula Xinis to five years in federal prison, followed by three years of supervised release, for conspiracy to commit health care fraud and wire fraud and for conspiracy to make false statements relating to health care matters in connection with a scheme to fraudulently bill Medicaid.  The defendant’s conviction stems from a scheme involving services purportedly provided by Holy Health Care Services, LLC (“Holy Health”), a mental health services provider with locations in Washington, D.C.  Judge Xinis also ordered Mbom to pay restitution in the full amount of the loss, $4,450,588.66.  The sentence was imposed on February 8, 2024.

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

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 so he or she can be capable of excellence.

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

Illinois Insurance Agent Sentenced to 7 Years in Prison for Swindling Premiums

Daniel M. Rosenbaum owned and operated Alexander & Rosenbaum Financial Group LLC, an insurance agency in Kenilworth, Ill. Beginning in 2016, Rosenbaum collected more than $1 million in annuity premiums from at least 18 clients, including friends and family members, for policies that he never purchased.

Rosenbaum, the owner of a suburban Chicago insurance agency has been sentenced to seven years in federal prison for swindling more than $1 million from clients by collecting annuity premiums for policies that he never purchased, the U.S. Attorney’s Office, Northern District of Illinois announced last week.

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

Ignore Court Orders at Your Peril

Frivolous Litigation and Frivolous Appeal Causes Default to Be Entered

PROOF OF FRAUDULENT CLAIM REQUIRED SUIT

Plaintiff-Appellee Transamerica Life Insurance Company (“Transamerica”) sued Defendants-Appellants Akop Arutyunyan and his daughter Anahit Arutyunyan for allegedly engaging in a conspiracy to defraud Transamerica into paying benefits under a long-term care insurance policy.

In Transamerica Life Insurance Company v. Akop Arutyunyan; Anahit Arutyunyan, No. 22-55199, United States Court of Appeals, Ninth Circuit (February 22, 2024) Transamerica sued to avoid paying benefits to a fraudulent disability claim.

You can read the full article and all of this issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/02/ZIFL-03-01-2024.pdf

(c) 2024 Barry Zalma & ClaimSchool, Inc.

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ZIFL-03-01-2024

About Barry Zalma

An insurance coverage and claims handling author, consultant and expert witness with more than 48 years of practical and court room experience.
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