Zalma’s Insurance Fraud Letter – April 1, 2024

ZIFL-04-01-2024 Volume 28, Number 7

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Post 4766

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 month’s issue contains multiple articles for the insurance fraud professional and the insurance claims professional. The current issue can be read in full at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf and includes the following articles:

Prison Employee Commits a Crime She Was Employed to Prevent

GUILTY OF WORKERS’ COMPENSATION FRAUD

On January 10, 2022, defendant Tiffinie Marvell Jones was convicted by a jury of one count of insurance fraud. Jones filed a motion for a new trial, which was denied. On appeal, Jones argued that there was insufficient evidence to support the verdict, that her trial counsel provided ineffective assistance, and that the trial court abused its discretion when it denied her motion for a new trial.

In The People v. Tiffinie Marvell Jones, F085205, California Court of Appeals, Fifth District (March 14, 2024) the Court of Appeals affirmed her conviction.

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf.

More McClenny Moseley & Associates Issues

This is ZIFL’s twenty fifth 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.

From the Coalition Against Insurance Fraud

The Top 5 Covid-19 Scams

  1. Fake “corona” insurance
  2. Cancelled health insurance
  3. corona medicines, tests
  4. Senior Scams
  5. Bogus Travel Insurance

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf.

Health Insurance Fraud Convictions

Physician Pays $95,000 to Resolve Allegations of Genetic Testing Fraud

Nishi Patel, MD, a physician who received his medical training at Drexel University, will pay $95,000 to resolve allegations that he violated the False Claims Act by ordering medically unnecessary genetic testing for Medicare beneficiaries.

Read the full article including dozens of convictions and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf.

New Book Now Available from Barry Zalma

Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition, 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

Public Insurance Adjuster Sentenced to Three Years in Prison After Stealing $108k From Homeowners, Gwinnett DA

Stephen E. Chastain, 62, represented a Gwinnett County couple as their insurance adjustor after their house burned in 2019, according to the Gwinnett County district attorney. According to the district attorney, it was stipulated that Chastain would take 15% of the settlement as his fee. The district attorney said the company “did very little work, and the victims never saw the entirety of their insurance settlement.”

Read the full article and the full issue of ZIFL at http://zalma.com/blog/wp-content/uploads/2024/03/ZIFL-04-01-2024-1.pdf.

SOFT FRAUD

How Most Get Away With Insurance Fraud

For reasons known only to governmental entities some insist on categorizing fraud into both “hard” and “soft” fraud. By so doing the governmental entities that so categorize fraud make one type of fraud less heinous and less criminal than the other. Fraud, whether categorized “soft” or “hard,” are criminal and if a person is tried and convicted of fraud both can be sent to jail for the same amount of time.

The types of insurance fraud some call “soft fraud” are found in every type of claim presented to an insurer.

Soft fraud, which is sometimes called opportunity fraud, occurs when a policyholder or claimant exaggerates a legitimate claim…. According to the Insurance Research Council, soft fraud is far more frequent than hard fraud. Because of the frequency of soft fraud, it adds more to overall claims cost than hard fraud does.

Soft fraud occurs when a policyholder exaggerates an otherwise legitimate claim or when an individual applies for an insurance policy and lies about certain conditions or circumstances to lower the policy’s premium.

Adapted from my Book, “Insurance Fraud – Second Edition” Available as a Kindle book; Available as a Hardcover;  Available as a Paperback 

Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455; Subscribe to Zalma on Insurance at locals.com https://zalmaoninsurance.local.com/subscribe. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Go to the podcast Zalma On Insurance at https://podcastrs.spotify.com/pod/show/barry-zalma/support Write to Mr. Zalma at zalma@zalma.com; http://www.zalma.com; http://zalma.com/blog; I publish daily articles at https://zalma.substack.com, Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/

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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