Zalma’s Insurance Fraud Letter – May 1, 2024

ZIFL Volume 28, Issue 9

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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:

What is Insurance Fraud?

Next to tax fraud, insurance fraud is the most practiced crime in the world. It is perpetrated by members of every race, religion, and nationality. It is found in every profession. The possibility of a tax-free profit when coupled with the commonly held belief that criminal prosecution will probably not occur, is sometimes too difficult for normally honest people to resist.

Adapted from my book  Insurance Fraud Volume I Second Edition Available as a Kindle book; Available as a Hardcover;  Available as a Paperback

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

Man Bites Dog & Dog Bites Back

Third Circuit Compels Arbitration of IFPA Qui Tam Claims

The Insurance Fraud Prevention Act (IFPA) allows insurers to sue health care providers pursuing insurers with assignments of benefits from personal injury protection (PIP) claims (no fault insurance) on behalf of the state. GEICO did so against multiple health care providers who asked the court to compel GEICO to arbitrate each potential fraud claim.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

More McClenny Moseley & Associates Issues

This is ZIFL’s twenty 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.

April 3, 2024 – Monson v. MMA, et al files a First Amended Complaint for Class Action and Damages in the USCA for the Southern District of Texas, Houston Division, Civil Action No. 4:23-cv-00928.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

Now Available New Book

 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 complete article and the full issue of ZIFL in Adobe .pdf format here.

Criminal Tries to Get Out of Sentence

Fraudster Fails to Obtain Post Conviction Relief

Robert Sitler appealed from the order that dismissed his petition filed pursuant to the Post Conviction Relief Act (“PCRA”). A jury found him guilty of homicide by vehicle and the trial court, sitting without a jury.

In Commonwealth Of Pennsylvania v. Robert Sitler, No. 2946 EDA 2022, J-S20044-23, Superior Court of Pennsylvania (April 11, 2024) the appellate court refused to provide relief for Sitler.

From the

Tyburious M. Heyward, an insurance fraud ringleader who specializes in staged automobile accidents, has pleaded guilty in Sumter, South Carolina.

Heyward recruited dozens of individuals to participate as drivers and passengers in intentional automobile collisions to collect insurance payouts for nonexistent injuries from multiple insurance companies. Heyward directed his co-conspirators to seek unnecessary medical treatment for specific, subjective injuries and symptoms. Heyward also provided and directed the use of false medical, residency, identity, and lost wages documents throughout the claims processes. Heyward previously served time in prison for similar conduct. In fact, while incarcerated in the South Carolina Department of Corrections, Heyward used a contraband cell phone to recruit others to conduct staged accidents at his direction in this recent case. This case was prosecuted by Special Assistant Attorney General Joshua Underwood, the Director of SCDOI’s Insurance Fraud Division and investigated by agents of the South Carolina Law Enforcement Division (SLED) Insurance Fraud Unit.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

Health Insurance Fraud Convictions

Doctor Convicted for $5.4M Medicare Fraud Scheme

Adarsh Gupta, M.D., 51, of Sewell, New Jersey, a federal jury convicted a New Jersey doctor today for causing the submission of over $5.4 million in fraudulent claims to Medicare for orthotic braces ordered through a telemarketing scheme.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

Insurer Immune from Malicious Prosecution Suit

SIU Report to State Made in Good Faith Makes it Immune from Suit for Malicious Prosecution

In The Hanover Insurance Group, Inc; and Michael Arline, Jr., v. Luke Frazier, No. 2D22-1689, Florida Court of Appeals, Second District (April 3, 2024) Luke Frazier sued The Hanover Insurance Group, Inc., and Michael Arline, Jr., an employee in Hanover’s Special Investigations Unit, for malicious prosecution.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

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

Self Proclaimed ‘Godfather’ Gets 54 Years In Prison About a $150M Southern California Workers’ Comp Scheme

Peyman Heidary, 53, a man, who Riverside County Superior Court records say called himself “The Godfather,” was ordered to serve 54 years in state prison and pay $23 million in fines for masterminding a criminal organization that attempted to bilk the state out of $150 million in a workers’ compensation fraud the District Attorney’s Office said on Monday, April 15.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

Criminal’s Money Stays With State

Assets Forfeited to State are not Subject to Attachment

In B.D. v. Sussex County Prosecutor’s Office, No. A-1781-22, Superior Court of New Jersey, Appellate Division (April 19, 2024) the court dealt with the claims of a victim of a sex offender who attempted to get assets of offender that was forfeited to the state.

In this declaratory judgment action, plaintiff, B.D., appealed from the Law Division’s order dismissing his complaint, in which he sought to obtain proceeds forfeited to the Sussex County Prosecutor’s Office (SCPO) in a related health care insurance fraud case.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

Houston Attorney Eric B. Dick Faces Sanction Again

Eric B. Dick, a well-known plaintiffs’ attorney in Houston, faces significant legal repercussions for the second time in recent months due to his litigation practices. Galveston County District Court Judge Kerry L. Neves recently ruled that Dick filed a groundless lawsuit against Standard Casualty Co. in bad faith, resulting in a summary judgment ordering Dick and the Dick Law Firm to reimburse the insurer over $100,000. This judgment follows a similar sanction of $137,000 in Harris County Civil Court against Dick for frivolous litigation against the same insurer.

Read the complete article and the full issue of ZIFL in Adobe .pdf format here.

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   for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com

Over the last 55 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.

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455

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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