Zalma’s Insurance Fraud Letter – September 1, 2019

Long Sentence for Insurance Fraud Plus Other Crimes

 Zalma’s Insurance Fraud Letter, Volume 23, No. 17        

Digests of Some of the articles you can read in this issue of ZIFL follow: 

 Long Sentence for Insurance Fraud Plus Other Crimes

Insurance Fraudster to Spend Years in Prison

Insurance fraud is a bad enough crime but when you add to it resisting arrest and running down two police officers who stopped the fraudster for a vehicle code violation, it takes a great deal of gall to claim the sentence is too harsh.
In Commonwealth of Pennsylvania v. Ishmael Ali Burk, J-S45038-19, No. 1516 EDA 2018, Superior Court of Pennsylvania (August 16, 2019) Ishmael Ali Burk (Burk) appealed from the judgment of sentence imposed by the Court of Common Pleas of Bucks County (trial court) after he pleaded guilty in case numbers 4724-2017 and 8580-2017.1. Specifically, he challenges the discretionary aspects of his sentence.

Have You Completed the Claims Training Required in September? 

California law requires that every claims handler or person qualified as an “integral anti-fraud personnel” be trained annually by September each year on the California Fair Claims Settlement Practices Regulations and the California SIU Regulations.
Barry Zalma has written two books – available as Kindle books or as paperbacks at http://zalma.com/blog/insurance-claims-library/ – to allow your people to qualify as persons who have fulfilled the requirements.

“California Fair Claims Settlement Practices Regulations”

Available as a Kindle book and as a paperback at http://zalma.com/blog/insurance-claims-library/ 

“California SIU Regulations”

The State of California Imposes Control on the Investigation of Insurance Fraud
Available as a Kindle Book and  as a paperback at http://zalma.com/blog/insurance-claims-library/

Health Insurance Fraud Convictions

NJ Woman Sentenced to Two Years Prison in $50 Million Fraud

Kristie Masucci was sentenced to 24 months behind bars after pleading guilty in October to conspiracy to commit health care fraud.
Masucci a recruiter for a widespread health care insurance fraud scheme in New Jersey. According to the office of U.S. Attorney Craig Carpenito, Masucci served as a recruiter for the scheme from January 2015 through February 2016. In her role Masucci persuaded individuals in New Jersey to obtain expensive and medically unnecessary compounded medications from an out-of-state pharmacy.
Earlier this year, seven people in New Jersey were charged in a compound pharmaceuticals scheme. Masucci and her co-conspirators recruited public employees and others covered by an unnamed pharmacy benefits administrator to obtain compounded medications from an out-of-state compounding pharmacy without any evaluation by a medical professional and, in return, the pharmacy paid one of Masucci’s conspirators a percentage of each prescription filled.
The pharmacy benefits administrator paid the compounding pharmacy more than $50 million for medications, including $1.8 million for prescriptions submitted by Masucci and her cohorts. Masucci received $388,608 for her role in the scheme.

Other Insurance Fraud Convictions

Appellate Court Upholds Santa Maria Man’s Murder Conviction 

Gabriel Antonio Espinoza was found guilty of killing his mother, Emma Posadas-Espinoza of Lompoc, over financial woes
A California appellate court has upheld the first-degree murder conviction of Espinosa, a Santa Maria man accused of killing his mother and dumping her body in Orange County five years ago.
Convicted in the murder of his mother, Gabriel Antonio Espinoza is serving a sentence of 25 years to life in state prison.
Espinoza, now 34, was arrested five months after the body of his mother, Emma Posadas-Espinoza, 58, of Lompoc, was discovered near an apartment complex in La Habra in July 2014.
While an Orange County Superior Court jury did not determine Espinoza killed his mother for financial gain, the panel found him guilty of first-degree murder, leading to the appeal filed by Santa Barbara attorney David Andreasen.

The Current Issue Contains the Following:

  • Long Sentence for Insurance Fraud Plus Other Crimes
  • Have You Completed the Claims Training Required in September?
  • Some Restitution for Consumers in Annuity Scam
  • Good News from the Coalition Against Insurance Fraud
  • Uberrimae Fidei
  • Health Insurance Fraud Convictions
  •  Other Insurance Fraud Convictions
  • Excellence in Claims Handling Courses From Experfy.com 
  • Insurance Claims Library

Zalma on Insurance – an Insurance Blog

The Zalma on Insurance blog has posted over 2650 digests of insurance appellate decisions and other important insurance materials and articles published five days or more a week and are available at http://zalma.com/blog.

Zalma’s Insurance 101 a Video Blog

It consists of 1022 three to four minute videos starting with “What is Insurance” and moving forward to insurance fraud investigations explaining the basics of insurance and insurance claims handling in a painless fashion that can be viewed every morning with the first cup of coffee at  Zalma’s Insurance 101.

If you start at Volume 1 at the bottom of the blog’s first page and view one or two videos a day you will have approximately 12 to 24 hours of training a year until you get to the last video.

The videoblog is adapted from my book, Insurance Claims: A Comprehensive Guide available at the Zalma Insurance Claims Library

 © 2019 – 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 50 years in the insurance business. He is available at http://www.zalma.com and zalma@zalma.com.

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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