ZALMA’S INSURANCE FRAUD LETTER   – May 15, 2020  

ZALMA’S INSURANCE FRAUD LETTER   

May 15, 2020  

Read the full Zalma’s Insurance Fraud Letter at https://lnkd.in/gFjGxv6 and at https://lnkd.in/gfZwXxi

Barry Zalma
On April 20, 2020 the California DOI issued a Significant Training Noncompliance This Past Year
 
During SIU compliance field examinations conducted this past year, the Fraud Division observed an alarming trend related to required anti-fraud training. We found some insurers did not conduct training, only partially conducted sections of their required anti-fraud training, or did not maintain documentation of this required training. These insurers were aware of the training requirements which meant the noncompliance was considered willful. These training findings resulted in some of the highest noncompliance penalties approved by the Insurance Commissioner this past year.
These examples follow:
Insurer #1- Our review found 96% of the integral anti-fraud employees we tested did not receive a new hire anti-fraud orientation.
Insurer #2- Our review found 90% of the integral anti-fraud employees we tested did not receive annual anti-fraud training.
Insurer #3- Our review found 70% of the SIU personnel we tested did not receive continuing anti-fraud training on any of the required topics.
Insurer #4- Our review found the insurer did not substantiate that 100% of their new integral anti-fraud hires received a mandated antifraud orientation.
Insurer #5- Our review found 60% of the insurer’s SIU personnel did not substantiate they received training that covered any of the required topics.
Insurer #6- Our review found 43% of the integral anti-fraud personnel we tested did not receive annual training, or the insurer did not substantiate they received training. Of these employees, about 50% indicated they received training; however, training records did not substantiate this fact.
If you wish to comply with the SIU Regulations consider The State of California Imposes Control on the Investigation of Insurance Fraud
California SIU Regulations is designed to assist California insurance claims personnel, claims professionals, independent insurance adjusters, special fraud investigators, private investigators who work for the insurance industry, the management in the industry, the attorneys who serve the industry, and all integral anti-fraud personnel working with California admitted insurers to comply with the requirements of California SIU Claims Regulations.
The state of California, by statute, requires all admitted insurers to maintain a Special Investigative Unit (an “SIU”) that complies with the requirements set forth in the Special Investigative Unit Regulations (the “SIU Regulations”) and train all integral anti-fraud personnel to recognize indicators of insurance fraud.
Cease and Desist Order to Protect Californians from illegal Extended Warranties Sales
The California Department of Insurance (CDI) issued a Cease and Desist Order effective immediately upon Omega Vehicle Services, LLC doing business as Delta Auto Protect, and its controlling manager, Charles Seruya, for allegedly selling illegal Vehicle Service Contracts (“VSCs”) to over twenty California consumers.
The Cease and Desist Order alleges both Delta Auto Protect and Seruya were not licensed by the Department of Insurance and improperly denied claims, illegally sold contracts they did not first file with the Department directly to consumers, and used an unapproved backup insurer.
Under the Order, Delta and Seruya are to immediately stop selling VSCs in any capacity and cease acting as an insurance agent or producer or in any other capacity in the State of California for which they do not hold a valid license, permit, or Certificate of Authorities.

Read the full article here.

Barry Zalma Speaks at Your Request  
A speaker on insurance, insurance claims handling, and insurance for any event at a reasonable cost at your location or by video. Go to Barry Zalma Speaks at Your Request click on link for details. Call 310-390-4455 or zalma@zalma.com

 Hallelujah: Texas Allows a Fraud Exception to the Eight Corners Rule

Texas Finds a Chink in the Eight Corners Rule
 
The eight-corners rule of insurance contract interpretation about duty to defend directs Texas courts to determine a liability insurer’s duty to defend its insured based on:
  • the pleadings against the insured and
  • the terms of the insurance policy.
For many years plaintiffs’ lawyers have taken advantage of the rule and with careful pleading have required an insurer to defend a suit that was probably not covered by the insurance policy.
In Loya Insurance Company v. Osbaldo Hurtado Avalos And Antonio Hurtado As Assignees of Karla Flores Guevara, No. 18-0837, Supreme Court of Texas (May 1, 2020) the Texas Supreme Court, in the face of an obvious fraud, was asked to create an exception to the eight corners rule.
Good News From the Coalition Against Insurance Fraud
* An ortho spine surgeon paid $1.75 million to settle a lawsuit accusing him of taking kickbacks from an ortho equipment maker in Newport News, Va. Dr. Jeffrey Carlson received kickbacks through a sham company for using SpineFrontier products. He received “consulting” payments for the time he spent performing surgeries. He already was paid for those hours by Medicare and other federal programs. Carlson also accepted meals for he and his staff every day he worked with a SpineFrontier product. That added up to thousands of dollars in food. Carlson is president and managing partner of Orthopaedic & Spine Center. He’s the 6th doc to settle a lawsuit alleging kickbacks from SpineFrontier. The feds filed a False Claims Act against the company in March.
* A local lab tested patients’ feces unnecessarily and falsely billed Medicare. Genova Diagnostics will pay $17-43 million to settle those allegations and others. The whistleblower suit highlighted 3 tests- the NutrEval and GI Effects Lab Test, which both analyze stool samples, and IgG allergen, a food-sensitivity test. Genova also engaged in improper billing, and paid 3 phlebotomy vendors in violation of the federal Stark Law, which prohibits physician self-referral.
* Try as she might, Eryn B. Meyers isn’t going anywhere. The Wayland, N.Y. woman is serving 23 years to life for burning down her house – and incinerating her housemate David O’Dell. Meyers and her husband Joseph did the deed for nearly $170,000 of insurance money. They were caregivers for O’Dell, who was mentally slowed by a head injury. Burning the old wooden house would net them $125,000, plus another $40,000 of life insurance they secretly took out on O’Dell. That would let them buy a snazzy new double-wide to live in. The home was reduced to charred rubble, and O’Dell had to be identified from the remains of his bones. Meyers appealed her 2017 conviction for insurance fraud, arson, murder and other crimes. She claimed ineffective lawyers. “Contrary to defendant’s contention, she was not denied effective assistance of counsel by the decision of her first defense counsel to withdraw a request for a Huntley hearing,” the state Supreme Court ruled. “It is well settled that ‘[t]here can be no denial of effective assistance of trial counsel arising from counsel’s failure to ‘make a motion or argument that has little or no chance of success'”
Guest Column on Insurance Fraud
In this the third month of the plague I decided that it was appropriate to ask a friend of long standing and experienced claims person to add to the wisdom of readers of ZIFL with the first ever guest column in ZIFL. Read, learn and enjoy.
You Will Never See a Good Fraud – The First Guest Column for ZIFL
I am Thomas McCloskey CPCU, LIC. I am a retired National / Executive General Adjuster. I retired after 45 years in the business. I still consult on claims and litigation on occasion. Barry Zalma has invited me to contribute to his fraud letter; I am honored and pleased.
I will attempt to approach this endeavor with the idea that claims people may find my musings amusing and maybe enlightening. We are all bored to tears with stories of frauds by those evil doers that underwriting failed to filter out of our pool of insureds. We forget that fraudsters are on all sides of this contract. Plaintiffs who plot to present injury claims, agents who will insure buildings if they can get a photo that does not show the firetrucks. The ocean of money the insurance industry represents will draw schemers. Some of whom are quite inventive.
As long as we are willing to suffer miscreants in our midst, we as a profession, will remain in the position given in want ads, between housekeepers and janitors. Adjusting is a profession requiring utmost honesty and an overly developed sense of fairness. Continuing education and professional development are essential. If you cannot commit to your own growth and commitment, please find another way to make a living. People who are too lazy to work and too nervous to steal, may be in our business, never in our profession.
For a vendor looking to make inroads to the company’s surplus fund, some strategy will need to be employed. Sending Stan the Donut Man to the various claims offices will raise your company’s name recognition, perhaps a referral or two. Taking adjusters to lunch and having the best selection of tickets will make your name well known.
A young auto adjuster was offered a case of steaks for every car towed into a specific shop. A young fire adjuster met the love of his life who was employed by a … wait for it… a fire repair contractor. Public Adjusters in Detroit were amazing. One had his name legally changed to Cash McCall. PA’s deserve their own edition. There are two people in a claims department that are gold mines, supervisors and clerical folks. They both have unlimited access to claims information.
In Metropolitan Detroit, a windstorm produced about 9,500 claims for a national carrier. In an effort to reduce the storm of paper flying about. Agents sent in policy number lists. These policy numbers were then entered into a terminal, a four-part form was produced with all the insured’s information required to handle the loss. Operations only used three.
Nancy Clerical was approached by Jimmie The Jet, owner of Disreputable Contracting. Mr. Jet perceptively noted the fourth part of the form was being discarded, farther Nancy Clerical was the lowest paid person in the operation. Slithering up to this less than reputable clerical person, offered her five dollars for each of the copies she was throwing away. This is potentially more money than two years’ salary TAX FREE.
Jimmie The Jet was an “armchair contractor.” That is, he did not own a hammer. Everything was subbed out, and the Jet screwed his subs and the insureds. However, The Jet or his salespeople could then approach a homeowner.
Hello, I am Jimmie the Jet. Your insurance company Shifting Sands Mutual is remarkably busy. They and your agent Mr. Pita have asked me to help you get your house repaired. I have been authorized to waive the deductible. Sign here. Do you have an insurance check?
This scheme worked well until Nancy Clerical arrived at the office for her morning shift driving a genuinely nice General Motors product. Raising the question of how she paid for the car.

Read the full article here. 

Other Insurance Fraud Convictions

NCWoman Who Killed Stepson, 4, By Shoving Plastic Down His Throat Also Had Her Husband Murdered 20 Years Later

Sylvia Ipock White , a North Carolina mother was found to be responsible for the deaths of her husband and her four-year-old stepson. Billy C White, a North Carolina insurance agent, was reported missing in 1992 by his wife, Sylvia Ipock White. Oxygen’s new documentary, ‘Snapped’, looks at the Kinston murders and how Sylvia was caught for the crimes.
Former Kinston Police assistant chief Wilburn ‘Speedy’ Ingram recalled Sylvia reporting Billy missing and shared, she’s crying, very hysterical and telling me that Billy went to meet a man somewhere out in the county to sell a large insurance policy and that he had not come home.
The two had married in 1971 and had a large family, including children from past marriages. They were together for around 20 years before Billy vanished.

Billy White Murder

The Kinston Police launched a massive search for Billy, which also included an aerial search. They found Billy’s car on a deserted woodland road. It was found that Billy had died from two shotgun blasts, one to his chest and the other to his side. His pockets had been turned out and his wedding ring was missing. White had told investigators that Billy had stepped out to meet a man named Timmy Connors who wanted to purchase an insurance policy. When authorities tried to find the man, they were met with a dead end.
While investigating Billy’s death, they came to find that Sylvia had been having an affair with a man named James for over a year. The two had checked into a hotel on the day Billy was killed. Given that Sylvia had an alibi and had no evidence against her, the case came to a standstill until a month later, when an anonymous caller revealed a huge tip. The informant revealed it had been two months since the party but he had run into the same man again. As they spoke, the man had admitted to killing Billy. He was found to be James Lynwood Taylor. After an eight-hour investigation, he confessed to the murder. He revealed that Sylvia had offered him $20,000 and a van to kill Billy as she wanted to claim his life insurance policy, which was approximately $200,000. Taylor then recruited his uncle, Ernest West Basden as a hitman.
Taylor had lured Billy and had posed as Timmy Connors when Basden emerged and shot him. Sylvia was arrested and charged with murder though she maintained her innocence.

Billy Jr Murder

The murder of Billy White led to the re-examination of Sylvia’s stepson Billy Jr’s death. The 4-year-old had died 20 years before Billy’s death. Taylor had told the authorities that while trying to recruit him to kill her husband, Sylvia had said, “It’s not that hard to do. I had a stepchild. I put a bag over it until it stopped breathing.”
In 1973, Sylvia had taken Billy Jr to the hospital and said he had swallowed plastic. His skin had turned white and he was pronounced dead on arrival. As per court documents, the doctors had taken out a large piece of plastic from his throat, and nurses who checked on him testified that the plastic had no chew marks, bites, or anything to indicate the child had eaten it.
The child’s death was ruled as a homicide and Sylvia was charged with first-degree murder. Sylvia, now 83, is currently housed at Raleigh’s North Carolina Correctional Institution for Women.
Fake Boat Fire & Theft
Robert John Mohamad, 53 arranged for his $65,000 boat to be destroyed in a fire, then lied about it being stolen and tried to claim insurance, was sentenced to two years in a Western Australian prison.
Mohamad did not light the fire himself but procured someone else to destroy the boat and a trailer at a Kalgoorlie quarry in January 2018. The father-of-two then made a false complaint to police that the boat and trailer had been stolen, and attempted to fraudulently gain benefit by putting a claim in with Club Marine Insurance.
Commercial gain was a factor in Mohamad’s offending, while his wife’s health issues and problems with his truck driving business were also factors, the WA District Court heard on Wednesday.
Judge Andrew Stavrianou accepted Mohamad was remorseful and unlikely to reoffend, but also noted the importance of general deterrence.
Mohamad, who pleaded guilty to three charges, will be eligible for parole after serving half his sentence.
Health Insurance Fraud Convictions

DOJ Settles False Claims Act Allegations with Seattle Physician, his Pain Clinics, and his Drug-Testing Lab

Agrees to pay $2 .85 million to settle allegations his clinics ordered medically unnecessary urine tests at his lab, paid for by government healthcare programs

Dr. Frank Danger Li agreed to pay $2.85 million to state and federal authorities to settle allegations his companies billed government entities for medically unnecessary urine drug tests. Dr. Li’s seven pain clinics closed in July 2016 when the Washington State Medical Quality Assurance Commission suspended his medical license for improperly monitoring prescriptions of powerful opioids. The settlement is a civil resolution unrelated to any criminal investigation or any action by state health regulators.
The investigation helped stop Dr. Li and the providers he supervised from continuing to prescribe dangerous and excessive amounts of opioids. As a result, the government is reclaiming more than one million Medicaid dollars for the unnecessary drug tests he ordered for his opioid prescription practice.
According to the settlement agreement, in addition to his pain clinics, Dr. Li owned drug-testing labs in Seattle and Everett. Northwest Analytics did urine drug testing for Li’s clinics. In July 2013, Li instituted a policy that, in nearly every instance, each patient being treated at Seattle Pain Centers had to have a full urine drug test panel every time they were seen by a provider. This policy resulted in thousands of medically unnecessary tests. The testing protocol did not follow state standards which recommended random testing of up to four times per year.
The settlement funds are divided as follows: restitution to Medicare of $1,590,265; restitution to TriCare of $123,000; restitution to the Railroad Retirement Board of $2,672, and restitution to Medicaid of $1,134,151 ($453,796 federal funds and $680,354 state funds). The settlement agreement details how the funds are to be paid over five years and various ways that the government claims are secured. The settlement amounts are based in part on Dr. Li’s ability to pay.
Dr. Li does not admit any wrongdoing as part of this settlement.

Woman Sentenced To 10 Months for Soliciting Kickbacks and Obstructing Justice

Theresa C. Merced , 81, of Kentucky was sentenced to five months imprisonment to be followed by five months of home detention, and was ordered to pay a $55,000 fine, by Chief U.S. District Judge Danny C. Reeves, following her convictions for soliciting kickbacks from a toxicology laboratory in exchange for urine drug testing referrals, lying to law enforcement agents about the kickback she received, and then attempting to cover up the kickback by requesting the alteration of certain financial records.
Merced, the office manager of a substance abuse treatment clinic in Jackson, Kentucky previously admitted that, between December 2018 and August 2019, she solicited kickbacks from the CEO of a toxicology lab in exchange for urine drug test referrals. In August 2019 the CEO delivered to Merced a $4,000 check as part of a larger package of promised inducements, which she caused to be cashed. When Merced was questioned about the check by law enforcement agents in September 2019, she denied knowledge of it, and stated that the $4,000 was probably a loan from the lab CEO to her husband. Shortly after her interview with the agents concluded, Merced called the lab CEO and asked that he alter the lab’s financial records so that the entry for the $4,000 check would say “rent/loan,” consistent with the lie she told the agents.
Under federal law, Merced must serve 85 percent of her prison sentence and will be under the supervision of the U.S. Probation Office for three years. As a special condition of her supervised release, Merced is prohibited from working in any capacity in which she influences referrals for medical testing.
Insurance fraud is not a good method of funding retirement.

$4.6 Million Health Care Fraud and Kickback Schemes Related to Genetic Testing

Kacey C. Plaisance , 38, of Altamonte Springs, Florida, pleaded guilty by videoconference before U.S. District Judge Brian R. Martinotti in Newark federal court to an information charging him with two counts of conspiracy to defraud the United States in connection with schemes to commit health care fraud and violate the Anti-Kickback Statute. Plaisance and five co-defendants were previously charged by indictment in September 2019 in connection with the conspiracies.
Plaisance admitted his role in using his company to defraud the Medicare Program in connection with fraudulent orders for genetic tests. According to documents filed in this case and statements made in court:
Plaisance and his conspirators operated Ark Laboratory Network LLC (“Ark”), a company that purported to operate a network of laboratories that facilitated genetic testing. Ark partnered with Privy Health Inc., a company that another conspirator operated, and another company to acquire DNA samples and Medicare information from hundreds of patients through various methods, including offering $75 gift cards to patients, all without the involvement of a treating health care professional. A co-defendant, Matthew S. Ellis, a physician based in Gainesville, served as the ordering physician who authorized genetic testing for hundreds of patients across the country that he never saw, examined, or treated. These included patients from New Jersey and other states where Ellis was not licensed to practice medicine. Ellis, Plaisance, and their conspirators submitted and caused to be submitted fraudulent orders for genetic tests to numerous clinical laboratories. These orders falsely certified that Ellis was the patients’ treating physician and, in some cases, falsely indicated that a patient had a personal or family history of cancer. In 2018 alone, Medicare paid clinical laboratories at least $4.6 million for genetic tests that Ellis ordered in this manner.
Plaisance and his conspirators entered into kickback agreements with certain clinical laboratories under which the laboratories paid Ark bribes in exchange for delivering DNA samples and orders for genetic tests. Ark concealed these kickback arrangements through issuing sham invoices to laboratories that purportedly reflected services provided at an hourly rate even though the parties had already agreed upon the bribe amount, which was based on the revenue the laboratories received from Medicare or an amount paid for each DNA sample. In 2018, the clinical laboratories paid Ark at least $1.8 million in bribes.
Each of the counts to which Plaisance pleaded guilty carry a maximum penalty of five years in prison and a fine of $250,000, or twice the gross grain or loss from the offense. Plaisance’s sentencing is scheduled for Sept. 17, 2020.

Dominican National Pleads Guilty to False Identity Crimes

Robely Eladio De Jesus Guerrero
, 32, pleaded guilty before U.S. District Court Judge Richard G. Stearns to one count of aggravated identity theft and one count of false representation of a Social Security number. A sentencing date has not yet been scheduled.
A Dominican national who previously resided in Lawrence, Massachusetts pleaded guilty May 8, 2020 in federal court in Boston to fraudulently applying for a Social Security number.
On Jan. 4, 2016, De Jesus Guerrero used the Social Security number of a U.S. citizen to submit a renewal application for a Massachusetts driver’s license under the victim’s name
The charge of aggravated identity theft carries a mandatory two-year prison sentence that must run consecutively to any other sentence imposed, up to one year of supervised release and a fine of up to $250,000. The charge of false representation of a Social Security number provides for a sentence of up to five years in prison, three years of supervised release and a fine of $250,000. Sentences are imposed by a federal district court judge based on the U.S. Sentencing Guidelines and other statutory factors.

Physician Pleads Guilty to Distribution of a Controlled Substance Without an Effective Prescription

Dr. Robin Ann Cox pleaded guilty May 6, 2020 to one count of Distribution of a Controlled Substance without an Effective Prescription. According to the plea agreement, Dr.Cox was employed by the Arkansas Medical Clinic (AMC) in Rogers, Arkansas. Cox and the owner of AMC contacted the DEA by telephone to report that prescriptions from Cox’ s previous employment had been fraudulently written and filled.
Cox
specifically identified a prescription for patient D.S. written on May 19, 2019 and filled on May 20, 2019, and a prescription for F. R. dated May 17, 2019 and filled on May 17, 2019. During the investigation into these prescriptions, the DEA discovered that Cox had written D.S. his/her prescription in the parking lot of a fast food restaurant in Fort Smith, Arkansas, in the Western District of Arkansas, Fort Smith Division.

Substance Abuse Treatment Provider Pays $295k To Settle Improper Billing Allegations

Connecticut Counseling Centers
(“CCC”) has entered into a civil settlement agreement with the federal and state governments in which it will pay more than $295,000 to resolve allegations that it caused overpayments to be paid by the Connecticut Medicaid Program.
CCC is a healthcare organization that provides outpatient substance abuse and mental health services in Connecticut, with clinics located in Fairfield and New Haven counties. The government’s allegations against CCC arise out of improper billing for urine drug testing services.
The State of Connecticut Department of Social Services (“DSS”) contracted with CCC to provide behavioral health and substance use disorder services to Medicaid beneficiaries. Medicaid reimburses methadone clinics, such as CCC, utilizing a weekly rate payment for each Medicaid patient provided methadone treatment. Regulations issued by the State of Connecticut in 2013 made it clear that the weekly payment was a “bundled” rate that included intake evaluation; initial physical examination; on-site drug abuse testing and monitoring; and individual, group and family counseling services.
On September 3, 2014, Medicaid issued a Provider Bulletin to all methadone clinics reminding them that the weekly rate payment included reimbursement for on-site drug abuse testing and monitoring.
On February 1, 2015, DSS published on its website an Audit Protocol for methadone clinics. The Audit Protocol stated that if a DSS audit found Medicaid paid another laboratory provider for drug testing within a week of the date a methadone clinic was paid for methadone treatment, Medicaid would reduce the methadone clinic’s payment for the methadone treatment service by the cost of the laboratory service.
DSS conducted an audit of CCC and found that both CCC and an independent laboratory billed Medicaid for drug testing performed by the laboratory, contrary to DSS’ weekly rate payment regulation. In January 2016, DSS issued an Audit Report that warned CCC that continued non-compliance with the weekly rate payment rule would result in financial disallowances in future audits.
The government alleges that despite clear guidance from the Medicaid program and the audit finding indicating that on-site drug testing was part of the bundled rate, CCC routinely referred urine drug tests for CCC’s patients to an outside, independent laboratory. As a result, Medicaid paid for the claims twice, once to CCC pursuant to the bundled rate and a second time to the outside laboratory.
To resolve its liability, CCC will pay $295,211 to the federal and state governments for conduct occurring between January 18, 2016 and December 31, 2016.

Doctor Pleads Guilty to Opioid Conspiracy and Health Care Fraud

Dr. Felicia Lyn Donald,
65, of Great Falls, Virginia organized, led, and operated a prescription “pill mill” from at least April 2016 through April 2020. Donald practiced medicine at For Women OB/GYN Associates and NOVA Addiction Center. Donald distributed over 1.2 million milligrams (mg) of Schedule II opioids at or above the Centers for Disease Control and Prevention (CDC) guideline for dosages that a practitioner should avoid, with a total street value of over $1.2 million, and illegally distributed at least 325,190 mg of oxycodone and other Schedule II controlled substances. Donald also committed health care fraud on numerous occasions in furtherance of her scheme.
Dr. Donald pleaded guilty May 4, 2020 to leading and organizing an extensive and illegal prescription distribution conspiracy and a related health care fraud scheme. According to court documents, Donald flagrantly violated her oath as a physician and put countless lives at risk. Additionally, Donald fraudulently prescribed Schedule II opioid pills that she illegally distributed to a close associate, knowing that this individual sold the prescriptions on the street for profit. Around the same time, Donald issued prescriptions to the close associate for alprazolam pills, which belongs to a class of drugs known as benzodiazepines. Donald admitted that the use of opioids with benzodiazepines is a dangerous combination of drugs that can make a person stop breathing, and could have killed or caused serious bodily injury to the close associate or to the ultimate users.
Donald admitted that she prescribed opioids to addicts and/or drug dealers who had traveled from out-of-state or long distances to her practice; individuals that informed Donald of their pending drug charges; individuals who Donald knew had failed urine toxicology screens; individuals who Donald knew were selling the pills that she prescribed to them; paying certain employees, in part, with opioid prescriptions rather than through pay checks; and giving blank prescriptions to certain members of her medical office staff and other co-conspirators for their personal use.
Donald attempted to conceal her patterns of illegal prescribing by falsifying medical records to make it appear as though individuals who were never her patients received examinations and medical care, when in fact they had not, and engaging in Medicaid fraud. Donald fraudulently issued prescriptions to others in the names of at least nine unwitting individuals, none of whom were her patients. Donald also issued prescriptions for high doses of oxycodone to multiple women who were pregnant.
Donald pleaded guilty to conspiracy to distribute and dispense controlled substances outside the usual course of professional practice and without a legitimate medical purpose, and health care fraud. She agreed to surrender her medical license and faces a maximum penalty of 30 years in prison when sentenced on August 21. Actual sentences for federal crimes are typically less than the maximum penalties. A federal district court judge will determine any sentence after taking into account the U.S. Sentencing Guidelines and other statutory factors.
 Read the full article here.

Consider Books to Show Your Appreciation to Your Insurer Clients or Claims Employees
Many insurers refuse to allow their employees to receive gifts from vendors.
If you wish to thank your insurance company clients for allowing you to represent their interest or if you wish to honor your claims personnel it is time to give them something that will be useful to them throughout the coming year and that will not offend insurer’s rules to avoid attempts to extort clients for business from insurer employees.
Videos describing important insurance issues described by Barry Zalma and available to anyone who views or subscribes to the YouTube account. Issues include insurance fraud, definition of insurance, insurance as a contract of personal indemnity, millions for defense and not a dime for tribute and the tort of bad faith.

Read the full article here.

New and Now Available from the Zalma Insurance Claims Library
The Insurance Examination Under Oath Second Edition

A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud

A Tool Available to Insurers to Thoroughly Investigate Claims and Work to Defeat Fraud.
The insurance Examination Under Oath (“EUO”) is a formal type of interview authorized by an insurance contract. It is taken under the authority provided by the agreement of the insurer, when he, she or it acquires a policy of insurance, to submit to a condition of the insurance contract that compels the insured to appear and give sworn testimony at the demand of the insurer. Failure to appear and testify is considered a breach of a material condition.

Read the full article here.

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