Health Insurance Fraud Convictions

A YouTube Video Reporting on Recent Health Insurance Fraud Convictions

No one knows how much insurance fraud takes from the public health insurance programs and insurance companies, because most succeed. The best guess is that it is a $80 billion to $300 billion every year. The government is trying to stop the bleed and has arrested and convicted some of the worst providers. This video reports on some recent convictions reported in the April 1, 2020 issue of Zalma’s Insurance Fraud Letter.

See the full Video at

Doctor Who Pleaded Guilty to Health Care Fraud for “Goodie Bags” Agrees to Resolve Civil Fraud and Controlled Substance Liability for $2.8 Million.Andrew M. Berkowitz, M.D., of Huntington Valley, PA, was sued by U.S. Attorney William M. McSwain announced that the United States filed a civil lawsuit against for engaging in healthcare fraud and improperly distributing and dispensing controlled substances. The civil complaint relates to criminal charges that were previously filed against Berkowitz and for which he has pleaded guilty. At the same time the new civil suit was filed, the United States also filed a proposed civil judgment, in which Berkowitz has agreed to pay a total of $2.8 million in civil damages and penalties under the False Claims Act, Controlled Substances Act, and in civil forfeiture, committed to never obtaining another controlled substance registration, and consented to a 20-year exclusion from Medicare and Medicaid. The consent judgment remains subject to court approval.

Villages Dermatologist Agrees To Pay More Than $1.7 Million To Settle False Claims Act Liability For Inflated Medicare Claims

Dr. Thi Thien Nguyen Tran and Village Dermatology and Cosmetic Surgery, L.L.C. have agreed to pay the United States $1.744 million to resolve allegations that they violated the False Claims Act by submitting inflated claims to Medicare for wound repairs related to Mohs surgery. Pittsburgh Resident Pleads Guilty To Conspiracy, Health Care Fraud And Aggravated Identity TheftTamika Adams, 43, pleaded guilty before United States District Judge Cathy Bissoon in federal court to one count each of conspiracy to defraud the Pennsylvania Medicaid program, health care fraud, and aggravated identity theft, United States Attorney Scott W. Brady announced today.

Federal Jury Finds Defendants Guilty Of Submitting False Claims To Medicare Under Civil False Claims ActJury verdict results in recovery of more than $10.85 million to the Medicare program Ted and Julie Cain of Ocean Springs, Mississippi, following a nine week trial, were convicted by a Gulfport jury. Ted Cain’s companies, Stone County Hospital (Wiggins) and Corporate Management, Inc. (Gulfport), and Tommy Kuluz, Chief Financial Officer of Corporate Management, Inc. violated the Civil False Claims Act.

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© 2020 – Barry Zalma

This article, and all of the blog posts on this site, digest and summarize cases published by courts of the various states and the United States.  The court decisions have been modified from the actual language of the court decisions, were condensed for ease of reading, and convey the opinions of the author regarding each case.

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 and

Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

Over the last 52 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 the Insurance Claims Library 

Subscribe to e-mail Version of ZIFL, it’s Free!

Read last two issues of ZIFL here.

Go to the Barry Zalma, Inc. web site here




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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