• Tom Homan and Kristi Noem: What Border Agents Think of Their Incoming Bosses
    https://www.dailysignal.com/2024/11/19/tom-homan-and-kristi-noem-what-border-agents-think-of-their-incoming-bosses/

    Border Patrol agents are “ecstatic” that immigration-enforcement veteran Tom Homan will serve as border czar in the second Trump administration, a union spokesman told The Daily Signal.

    “We have somebody now that’s [come up] within the ranks,” Manny Bayon, president of the National Border Patrol Council for the San Diego area, said of Homan. “He was an Immigration and Customs Enforcement director before, and he wants to fix it.”

    On Nov. 10, Trump named Homan border czar for his incoming administration.
    Tom Homan and Kristi Noem: What Border Agents Think of Their Incoming Bosses https://www.dailysignal.com/2024/11/19/tom-homan-and-kristi-noem-what-border-agents-think-of-their-incoming-bosses/ Border Patrol agents are “ecstatic” that immigration-enforcement veteran Tom Homan will serve as border czar in the second Trump administration, a union spokesman told The Daily Signal. “We have somebody now that’s [come up] within the ranks,” Manny Bayon, president of the National Border Patrol Council for the San Diego area, said of Homan. “He was an Immigration and Customs Enforcement director before, and he wants to fix it.” On Nov. 10, Trump named Homan border czar for his incoming administration.
    WWW.DAILYSIGNAL.COM
    Tom Homan and Kristi Noem: What Border Agents Think of Their Incoming Bosses
    Border Patrol agents are “ecstatic,” for Tom Homan to serve as border czar under the Trump administration, Manny Bayon told The Daily Signal.
    0 Yorumlar 0 hisse senetleri 14 Views
  • Kash Patel Displays Why He Is the Best Pick for FBI Chief – Explains How Americans Can Regain Trust in Chris Wray’s Rogue Law Enforcement Agency (VIDEO)

    (IMHO: THE TOP TRAITORS, TYRANTS, AND THEIR HENCHMEN MUST BE ARRESTED, AND HANGED!!!!!...NO DELAYS, NO EXCUSES, NO EXCEPTIONS, NO "AMNESTY", NO MERCY!!!..).

    https://www.thegatewaypundit.com/2024/11/kash-patel-displays-why-he-is-best-pick/
    Kash Patel Displays Why He Is the Best Pick for FBI Chief – Explains How Americans Can Regain Trust in Chris Wray’s Rogue Law Enforcement Agency (VIDEO) (IMHO: THE TOP TRAITORS, TYRANTS, AND THEIR HENCHMEN MUST BE ARRESTED, AND HANGED!!!!!...NO DELAYS, NO EXCUSES, NO EXCEPTIONS, NO "AMNESTY", NO MERCY!!!..). 💩💥 https://www.thegatewaypundit.com/2024/11/kash-patel-displays-why-he-is-best-pick/
    Like
    3
    0 Yorumlar 0 hisse senetleri 220 Views
  • Border Czar Tom Homan delivers a stern warning to Boston Mayor Michelle Wu over her refusal to assist the Trump administration in deporting undocumented immigrants.

    “I would suggest she read Title 8 United States Code 13.24 III. That says you can’t harbor [or] conceal illegal aliens from law enforcement officers.”
    Border Czar Tom Homan delivers a stern warning to Boston Mayor Michelle Wu over her refusal to assist the Trump administration in deporting undocumented immigrants. “I would suggest she read Title 8 United States Code 13.24 III. That says you can’t harbor [or] conceal illegal aliens from law enforcement officers.”
    0 Yorumlar 0 hisse senetleri 511 Views 2
  • Police should be REQUIRED BY LAW to have an active insurance policy for general liability, to pay out the lawsuits and police misconduct claims!

    And those cops should also be CRIMINALLY CHARGED under federal law, Title 18 U.S.C. § 241 and 18 U.S.C. § 242 every single time they violate the rights of Americans!


    I have been telling people this for YEARS!

    I install replacement windows for a living.....
    My job REQUIRES me to purchase a ONE MILLION DOLLAR general liability insurance policy. Without it I can't work!

    I DON'T carry a gun, shoot people, taze people, bust out people's car windows, imprison people with torture cuffs, or put people into a cage while I'm at work.....

    I simply install windows, and MUST HAVE liability insurance!

    Don't you think it's beyond reasonable to ask that #Police Officers be REQUIRED BY LAW to carry a general liability insurance policy, just like I have to have, since they DO all of the things listed above!

    They DO carry a gun, they DO commit violence against other Americans, they DO put people into shackles, they DO damage the property of Americans, and they DO harm Americans on a regular basis

    Is it REALLY necessary for ME to be forced to have general liability insurance in order to "Change a window" when we have
    MEN IN BODY ARMOR WITH GUNS AND TASERS who don't have insurance?

    You see..... Police definitely DON'T WANT to be required to purchase their own insurance policy! Do you know WHY???

    I'll tell you... If these Police had their own liability insurance every time that an American citizen wins a case of police brutality or misconduct, and / or wrongful death when they kill the innocent..

    THEIR INSURANCE WOULD HAVE TO PAY THE LAWSUIT!
    And that would make their premiums go up...

    And when it has happened several times
    (Like happens with bad cops) their policy would be CANCELLED leaving them unable to ever work as a police officer again!

    This is something that MUST HAPPEN!
    We can no longer tolerate a #Criminal gang of blue line thugs who are "Above the Law" and are NEVER HELD ACCOUNTABLE!

    And body cameras should be MANDATORY and activated throughout the shift of ALL POLICE OFFICERS!

    If they turn them off it should be an automatic 25 years in prison!

    The body cameras and dash cameras should be LIVE-STREAMED to servers controlled by CITIZEN OVERSIGHT COMMITTEES of regular Americans (Like myself and James Freeman) and to Police headquarters, after a 5 minute delay

    THE AMERICAN PEOPLE should NEVER get a redacted version of the body cameras, after all, THEY ARE THE BOSS!

    Every body camera in America should be viewable after a 5 minute delay, it should be released for ANYONE to look at it, at any time, and for any reason... and under NO CIRCUMSTANCES should it be edited whatsoever!

    STOP enabling criminal behavior by Police!
    STOP enabling criminals to walk free among us!

    DEMAND POLICE ACCOUNTABILITY WITH EVERY BREATHE YOU TAKE, RIGHT UP UNTIL THE VERY LAST ONE!

    Because if you should fail to do this....
    Your children and grandchildren will live as #Slaves and under #Tyranny

    https://www.minds.com/newsfeed/1651406135372025867
    Police should be REQUIRED BY LAW to have an active insurance policy for general liability, to pay out the lawsuits and police misconduct claims! And those cops should also be CRIMINALLY CHARGED under federal law, Title 18 U.S.C. § 241 and 18 U.S.C. § 242 every single time they violate the rights of Americans! I have been telling people this for YEARS! I install replacement windows for a living..... My job REQUIRES me to purchase a ONE MILLION DOLLAR general liability insurance policy. Without it I can't work! I DON'T carry a gun, shoot people, taze people, bust out people's car windows, imprison people with torture cuffs, or put people into a cage while I'm at work..... I simply install windows, and MUST HAVE liability insurance! Don't you think it's beyond reasonable to ask that #Police Officers be REQUIRED BY LAW to carry a general liability insurance policy, just like I have to have, since they DO all of the things listed above! They DO carry a gun, they DO commit violence against other Americans, they DO put people into shackles, they DO damage the property of Americans, and they DO harm Americans on a regular basis Is it REALLY necessary for ME to be forced to have general liability insurance in order to "Change a window" when we have MEN IN BODY ARMOR WITH GUNS AND TASERS who don't have insurance? You see..... Police definitely DON'T WANT to be required to purchase their own insurance policy! Do you know WHY??? I'll tell you... If these Police had their own liability insurance every time that an American citizen wins a case of police brutality or misconduct, and / or wrongful death when they kill the innocent.. THEIR INSURANCE WOULD HAVE TO PAY THE LAWSUIT! And that would make their premiums go up... And when it has happened several times (Like happens with bad cops) their policy would be CANCELLED leaving them unable to ever work as a police officer again! This is something that MUST HAPPEN! We can no longer tolerate a #Criminal gang of blue line thugs who are "Above the Law" and are NEVER HELD ACCOUNTABLE! And body cameras should be MANDATORY and activated throughout the shift of ALL POLICE OFFICERS! If they turn them off it should be an automatic 25 years in prison! The body cameras and dash cameras should be LIVE-STREAMED to servers controlled by CITIZEN OVERSIGHT COMMITTEES of regular Americans (Like myself and James Freeman) and to Police headquarters, after a 5 minute delay THE AMERICAN PEOPLE should NEVER get a redacted version of the body cameras, after all, THEY ARE THE BOSS! Every body camera in America should be viewable after a 5 minute delay, it should be released for ANYONE to look at it, at any time, and for any reason... and under NO CIRCUMSTANCES should it be edited whatsoever! STOP enabling criminal behavior by Police! STOP enabling criminals to walk free among us! DEMAND POLICE ACCOUNTABILITY WITH EVERY BREATHE YOU TAKE, RIGHT UP UNTIL THE VERY LAST ONE! Because if you should fail to do this.... Your children and grandchildren will live as #Slaves and under #Tyranny https://www.minds.com/newsfeed/1651406135372025867
    WWW.MINDS.COM
    Police should be REQUIRED BY LAW to have an active insurance policy for general liability, to pay out the lawsuits and police misconduct claims! And those cops should also be CRIMINALLY CHARGED under federal law, Title 18 U.S.C. ?? 241 an... | Minds
    ...nce policy for general liability, to pay out the lawsuits and police misconduct claims! And those cops should also be CRIMINALLY CHARGED under federal law, Title 18 U.S.C. ?? 241 and 18 U.S.C. ...
    0 Yorumlar 0 hisse senetleri 1K Views
  • https://lawenforcementtoday.com/two-illegal-aliens-attack-nypd-officers-one-was-found-to-be-in-possession-of-an-ar-style-rifle
    https://lawenforcementtoday.com/two-illegal-aliens-attack-nypd-officers-one-was-found-to-be-in-possession-of-an-ar-style-rifle
    LAWENFORCEMENTTODAY.COM
    Two illegal aliens attack NYPD officers, one was found to be in possession of an AR-style rifle
    Two illegal aliens- including one with a violent gang tattoo- were charged with attacking two NYPD officers in a Bronx su...
    0 Yorumlar 0 hisse senetleri 337 Views
  • Recent congressional hearings have focused on the alleged recovery and reverse engineering of unidentified anomalous phenomena (UAPs), commonly referred to as UFOs. Witnesses have claimed the existence of secret government programs aimed at understanding and replicating advanced technologies from these objects. However, the Pentagon has denied these claims, stating that they have no verifiable information to support them. The topic of UAPs and potential reverse engineering has sparked debate and speculation. Some believe that the government is withholding crucial information from the public, while others remain skeptical of the claims.

    The potential implications of successful UAP reverse engineering are significant. It could lead to revolutionary advancements in various fields, including propulsion, materials science, and energy technology. However, it could also raise ethical concerns about the use of such advanced technology and its potential impact on society.
    Recent congressional hearings have focused on the alleged recovery and reverse engineering of unidentified anomalous phenomena (UAPs), commonly referred to as UFOs. Witnesses have claimed the existence of secret government programs aimed at understanding and replicating advanced technologies from these objects. However, the Pentagon has denied these claims, stating that they have no verifiable information to support them. The topic of UAPs and potential reverse engineering has sparked debate and speculation. Some believe that the government is withholding crucial information from the public, while others remain skeptical of the claims. The potential implications of successful UAP reverse engineering are significant. It could lead to revolutionary advancements in various fields, including propulsion, materials science, and energy technology. However, it could also raise ethical concerns about the use of such advanced technology and its potential impact on society.
    0 Yorumlar 0 hisse senetleri 1K Views

  • Zalma’s Insurance Fraud Letter September 15, 2024

    Zalma’s Insurance Fraud Letter

    A ClaimSchool™ Publication © 2024 Barry Zalma & ClaimSchool, Inc.

    Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkycVolume 28, Issue 21 – November 15, 2024

    “Honor, justice, and humanity, forbid us tamely to surrender that freedom which we received from our gallant ancestors, and which our innocent posterity have a right to receive from us. We cannot endure the infamy and guilt of resigning succeeding generations to that wretchedness which inevitably awaits them if we basely entail hereditary bondage on them.”

    Thomas Jefferson

    Insurance Fraud Requires Doctor to Lose his License

    Sexual Misconduct, Fraud, Bribery & Unnecessary Surgery Revokes License

    Louis Quartararo appealed from an August 22, 2022 final agency decision of the State Board of Medical Examiners (Board), revoking his license to practice medicine and surgery in New Jersey. The Superior Court of New Jersey, in In The Matter Of The Suspension Or Revocation Of The License Of Louis Quartararo, M.D. License No. 25MA07137700 To Practice Medicine And Surgery In The State Of New Jersey, No. A-0425-22, Superior Court of New Jersey, Appellate Division (October 31, 2024) affirmed the revocation.

    The Board charged Dr. Quartararo with engaging in sexual contact with patients; negligent acts by performing surgeries with co-surgeons who lacked the requisite privileges; and acts of fraud, deception and misrepresentation by miscoding procedures on patient operative reports and listing procedures in the reports he had not performed for the purpose of ensuring insurance coverage.

    FACTS

    Quartararo was a physician and Board-certified orthopedic surgeon licensed to practice medicine in New Jersey.

    Approximately one week before K.D. was scheduled to meet with Board investigators, Quartararo gave K.D. $20,916, which K.D. told an investigator was “for school.” Later, Quartararo’s attorney offered her more money to retract the statement she had made to the Board about her relationship with Quartararo.

    THE OAL HEARING

    At a formal hearing, the Board’s expert, Dr. Ashraf addressed Quartararo’s treatment of patient Y.O. revealed that the surgical procedures Quartararo performed were not medically necessary. In reviewing the description of Quartararo’s procedure on Y.O.’s spine, Dr. Ashraf concluded that Quartararo’s surgery on Y.O.’s completely normal spine “is gross negligence.”

    Regarding the fraud claims alleging that Quartararo had failed to properly code surgical procedures that he performed on E.S., D.C., Y.O., L.V., D.E., and V.C., Dr. Ashraf testified that the “whole function” of the “operations” section on the first page of the operative report was to list the procedures that were performed during the operation and he testified that, despite “laminotomy” appearing on the first page of V.C.’s and D.C.’s reports, their post-surgery MRIs revealed that laminotomies had not been performed.

    THE ALJ’S DECISION

    The Administrative Law Judge (ALJ) issued a comprehensive seventy-nine-page decision and concluded that Quartararo had “engaged in gross malpractice, professional misconduct, failure to comply with regulations administered by the Board, and failure to be of good moral character.”

    On August 22, 2022, the Board filed its final decision, revoking Quartararo’s license for a minimum of seven years from the date of voluntary surrender, April 5, 2019. The Board concluded that Quartararo’s “misconduct warrants a serious penalty in excess of that recommended by [the ALJ]” and that he “flagrantly ignored, and in fact shattered professional norms when he engaged in sexual misconduct with patients Y.R. and K.D.” The Board found Quartararo’s conduct was “so egregious that the only appropriate discipline is a license revocation.”

    The Board also imposed an aggregate monetary sanction of $343,909.75, comprised of a civil penalty of $90,000, $61,684.75 in costs, and $192,225 in attorney’s fees.

    Quartararo Argued

    The Board determined that revocation was warranted because he preyed on two vulnerable patients employed intimidation and coercion tactics to dissuade at least one of his victims-K.D.- from testifying about the true nature of their relation and resorted to making threats resulting in the issuance of a temporary restraining order against him.

    Quartararo admitted he had not performed laminotomies and that he had used the laminotomy code to ensure that he would be paid by insurance carriers. He did so rather than correctly coding the procedures he actually performed because of the risk he would otherwise not be paid.

    ZIFL OPINION

    Quartararo admitted before the ALJ that he committed fraud by billing insurers for laminotomies that he did not perform. As such he admitted to committing a federal as well as a New Jersey felony that should be presented to the US Attorney and the local District Attorney for prosecution. He lost his license because he took advantage sexually of vulnerable patients, committed gross acts of malpractice and profited from knowing insurance fraud. The people of New Jersey are now safe from his criminal and unprofessional conduct for a few more years, and in my opinion he should be prosecuted and sentenced to prison for the fraud.

    Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkyc

    IT PAYS INSURER DEFENDANTS TO INVESTIGATE INJURY CLAIMS

    In Chris Kallco v. Melissa Lynn Pugh, Chris Kallco, and Precise Mri Of Michigan, LLC v. Citizens Insurance Company Of The Midwest and Melissa Lynn Pugh, No. 368156, Court of Appeals of Michigan (October 30, 2024) affirmed the trial court’s decision.

    Plaintiff appealed from two orders granting summary disposition in favor of defendants even though he failed to respond to either motion.

    FACTUAL BACKGROUND

    This case arises out of a motor vehicle accident that occurred on March 9, 2020 involving plaintiff and Pugh. Plaintiff alleges that he sustained injuries from the accident. A year after the accident, plaintiff brought a negligence claim against Pugh, alleging that, because of Pugh’s negligence, plaintiff sustained “severe permanent and progressive personal injuries and serious impairment of a body function, including but not necessarily limited to: Head, Neck, Back, Shoulders ….” Plaintiff also brought a claim against Citizens for PIP benefits, including medical expenses, work loss, and replacement services.

    Pugh and Citizens moved for summary disposition arguing that plaintiff could not meet his burden of showing that he sustained a threshold injury under the no-fault act and, therefore, he could not maintain his negligence claim against her. Pugh submitted the deposition testimony of the plaintiff and the report of an independent medical examination (IME) conducted by Dr. James Bragman on December 27, 2021. Dr. Bragman further observed that plaintiff had “near full range of motion” in his neck and that he was “eminently capable” of standing and touching his toes despite his refusal to do so. Dr. Bragman noted that plaintiff had “very little” medical treatment documented in his records and that he had been undergoing physical therapy for six months with no medical basis for doing so. An investigator’s report includes pictures of plaintiff walking, riding a child’s bicycle, squatting, bending over, lifting a bicycle out of a minivan unassisted, playing with a dog, driving a car, and twisting his neck.

    Citizens’ motion argued that plaintiff made material misrepresentations to Citizens regarding the extent of his injuries, which rendered him ineligible for benefits.

    The trial court found that, based upon the evidence presented, plaintiff failed to establish that he sustained a serious impairment of body function and therefore summary disposition in favor of Pugh was appropriate.

    THRESHOLD INJURY

    Plaintiff argued that the trial court erred by granting summary disposition in favor of Pugh.

    Under the no fault statute, the threshold question of whether the person has suffered a serious impairment of body function should be determined by the court as a matter of law as long as there is no factual dispute regarding the nature and extent of the person’s injuries that is material to determining whether the threshold standards are met.

    Plaintiff was obligated to respond to Pugh’s motion in order to meet his burden of demonstrating that a fact question existed as to whether he suffered a serious impairment of body function.

    The parts of plaintiff’s deposition identified by Pugh do not establish a genuine issue of material fact as to whether he suffered a serious impairment of body function. The relevant portions of plaintiff’s deposition testimony fail to rebut the evidence and instead set forth, at best, mere subjective complaints of pain.

    FRAUDULENT INSURANCE ACT

    The fraud statute finds that a person who presents or causes or to be presented an oral or written statement knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act under that is subject to the penalties imposed under the statute. A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment of PIP benefits.

    An individual commits a “fraudulent insurance act” when: (1) the person presents or causes to be presented an oral or written statement, (2) the statement is part of or in support of a claim for no-fault benefits, and (3) the claim for benefits was submitted to the MAIPF. Further, (4) the person must have known that the statement contained false information, and (5) the statement concerned a fact or thing material to the claim.

    ZIFL OPINION

    The evidence presented by the defendants were damning since they established the injuries claimed were false. Plaintiff failed to respond to the motions to his detriment and sought reconsideration without any admissible evidence that he was truly injured. The defendants established that the Plaintiff committed fraud and he is lucky that this was a civil finding not a criminal proceeding that, in my opinion, should be presented by the prosecutor.

    More McClenny Moseley & Associates Issues

    This is ZIFL’s thirty 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 may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

    Health Insurance Fraud Convictions
    Pharmacist and Brother Convicted of $15M Medicare, Medicaid, and Private Insurer Fraud Scheme

    Raad Kouza, a pharmacist in Wayne County, Michigan, and his brother, Ramis Kouza, of Oakland County, Michigan, billed Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for prescription medications that they did not dispense at pharmacies they owned or operated in Michigan. A federal jury convicted the pharmacy owner and his brother November 8, 2024 for conspiracy to commit health care fraud and wire fraud.

    Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf

    Indicators of Bad Faith Set Up

    Some of the more common red flags of a bad faith set-up include the following:

    The claimant makes a policy limits settlement demand quickly after an accident, thereby depriving the insurer of the ability to conduct a full investigation.
    Quick demands that are combined with a limited amount of time to accept, again, in the hopes that records cannot be obtained and the investigation cannot be completed within that limited time period, and the settlement will be refused.
    The claimant makes a settlement offer with one or more unusual acceptance conditions.
    The involvement of the claimant’s counsel pre-dates certain medical or psychiatric care (e.g., testing and treatment for alleged mild traumatic brain injury)

    Read the full article and the full issue of ZIFL at http://https//zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024.pdf

    Convictions of Other Than Health Insurance Fraud
    Star in Reality TV Series Pleads Guilty Crop Insurance Fraud

    Steve A. McBee, 52, waived his right to a grand jury and pleaded guilty to a federal information that charges him with one count of federal crop insurance fraud. McBee, a Missouri farmer who appears in a reality TV show about his family’s farming operation pleaded guilty this week to a multi-million dollar fraud scheme involving federal crop insurance benefits.

    Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf

    Chutzpah – STOLI Fraudster Claims Hardship
    Felon Seeks Release from Home Confinement in Luxury Apartment in New York City

    Insurance Fraud is a serious crime, especially when it takes advantage of the elderly to defraud insurers in a Stranger Originated Life Insurance (STOLI) scheme. In United States Of America v. Michael Binday, No. 12 CR 152 (CM), United States District Court, S.D. New York (November 4, 2024) the defendant continued to use the wealth he gained from his fraud to impose on the courts of the United States with frivolous and unfounded motions.

    Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf

    Barry Zalma, Esq., CFE

    Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
    Zalma’s Insurance Fraud Letter September 15, 2024 Zalma’s Insurance Fraud Letter A ClaimSchool™ Publication © 2024 Barry Zalma & ClaimSchool, Inc. Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkycVolume 28, Issue 21 – November 15, 2024 “Honor, justice, and humanity, forbid us tamely to surrender that freedom which we received from our gallant ancestors, and which our innocent posterity have a right to receive from us. We cannot endure the infamy and guilt of resigning succeeding generations to that wretchedness which inevitably awaits them if we basely entail hereditary bondage on them.” Thomas Jefferson Insurance Fraud Requires Doctor to Lose his License Sexual Misconduct, Fraud, Bribery & Unnecessary Surgery Revokes License Louis Quartararo appealed from an August 22, 2022 final agency decision of the State Board of Medical Examiners (Board), revoking his license to practice medicine and surgery in New Jersey. The Superior Court of New Jersey, in In The Matter Of The Suspension Or Revocation Of The License Of Louis Quartararo, M.D. License No. 25MA07137700 To Practice Medicine And Surgery In The State Of New Jersey, No. A-0425-22, Superior Court of New Jersey, Appellate Division (October 31, 2024) affirmed the revocation. The Board charged Dr. Quartararo with engaging in sexual contact with patients; negligent acts by performing surgeries with co-surgeons who lacked the requisite privileges; and acts of fraud, deception and misrepresentation by miscoding procedures on patient operative reports and listing procedures in the reports he had not performed for the purpose of ensuring insurance coverage. FACTS Quartararo was a physician and Board-certified orthopedic surgeon licensed to practice medicine in New Jersey. Approximately one week before K.D. was scheduled to meet with Board investigators, Quartararo gave K.D. $20,916, which K.D. told an investigator was “for school.” Later, Quartararo’s attorney offered her more money to retract the statement she had made to the Board about her relationship with Quartararo. THE OAL HEARING At a formal hearing, the Board’s expert, Dr. Ashraf addressed Quartararo’s treatment of patient Y.O. revealed that the surgical procedures Quartararo performed were not medically necessary. In reviewing the description of Quartararo’s procedure on Y.O.’s spine, Dr. Ashraf concluded that Quartararo’s surgery on Y.O.’s completely normal spine “is gross negligence.” Regarding the fraud claims alleging that Quartararo had failed to properly code surgical procedures that he performed on E.S., D.C., Y.O., L.V., D.E., and V.C., Dr. Ashraf testified that the “whole function” of the “operations” section on the first page of the operative report was to list the procedures that were performed during the operation and he testified that, despite “laminotomy” appearing on the first page of V.C.’s and D.C.’s reports, their post-surgery MRIs revealed that laminotomies had not been performed. THE ALJ’S DECISION The Administrative Law Judge (ALJ) issued a comprehensive seventy-nine-page decision and concluded that Quartararo had “engaged in gross malpractice, professional misconduct, failure to comply with regulations administered by the Board, and failure to be of good moral character.” On August 22, 2022, the Board filed its final decision, revoking Quartararo’s license for a minimum of seven years from the date of voluntary surrender, April 5, 2019. The Board concluded that Quartararo’s “misconduct warrants a serious penalty in excess of that recommended by [the ALJ]” and that he “flagrantly ignored, and in fact shattered professional norms when he engaged in sexual misconduct with patients Y.R. and K.D.” The Board found Quartararo’s conduct was “so egregious that the only appropriate discipline is a license revocation.” The Board also imposed an aggregate monetary sanction of $343,909.75, comprised of a civil penalty of $90,000, $61,684.75 in costs, and $192,225 in attorney’s fees. Quartararo Argued The Board determined that revocation was warranted because he preyed on two vulnerable patients employed intimidation and coercion tactics to dissuade at least one of his victims-K.D.- from testifying about the true nature of their relation and resorted to making threats resulting in the issuance of a temporary restraining order against him. Quartararo admitted he had not performed laminotomies and that he had used the laminotomy code to ensure that he would be paid by insurance carriers. He did so rather than correctly coding the procedures he actually performed because of the risk he would otherwise not be paid. ZIFL OPINION Quartararo admitted before the ALJ that he committed fraud by billing insurers for laminotomies that he did not perform. As such he admitted to committing a federal as well as a New Jersey felony that should be presented to the US Attorney and the local District Attorney for prosecution. He lost his license because he took advantage sexually of vulnerable patients, committed gross acts of malpractice and profited from knowing insurance fraud. The people of New Jersey are now safe from his criminal and unprofessional conduct for a few more years, and in my opinion he should be prosecuted and sentenced to prison for the fraud. Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkyc IT PAYS INSURER DEFENDANTS TO INVESTIGATE INJURY CLAIMS In Chris Kallco v. Melissa Lynn Pugh, Chris Kallco, and Precise Mri Of Michigan, LLC v. Citizens Insurance Company Of The Midwest and Melissa Lynn Pugh, No. 368156, Court of Appeals of Michigan (October 30, 2024) affirmed the trial court’s decision. Plaintiff appealed from two orders granting summary disposition in favor of defendants even though he failed to respond to either motion. FACTUAL BACKGROUND This case arises out of a motor vehicle accident that occurred on March 9, 2020 involving plaintiff and Pugh. Plaintiff alleges that he sustained injuries from the accident. A year after the accident, plaintiff brought a negligence claim against Pugh, alleging that, because of Pugh’s negligence, plaintiff sustained “severe permanent and progressive personal injuries and serious impairment of a body function, including but not necessarily limited to: Head, Neck, Back, Shoulders ….” Plaintiff also brought a claim against Citizens for PIP benefits, including medical expenses, work loss, and replacement services. Pugh and Citizens moved for summary disposition arguing that plaintiff could not meet his burden of showing that he sustained a threshold injury under the no-fault act and, therefore, he could not maintain his negligence claim against her. Pugh submitted the deposition testimony of the plaintiff and the report of an independent medical examination (IME) conducted by Dr. James Bragman on December 27, 2021. Dr. Bragman further observed that plaintiff had “near full range of motion” in his neck and that he was “eminently capable” of standing and touching his toes despite his refusal to do so. Dr. Bragman noted that plaintiff had “very little” medical treatment documented in his records and that he had been undergoing physical therapy for six months with no medical basis for doing so. An investigator’s report includes pictures of plaintiff walking, riding a child’s bicycle, squatting, bending over, lifting a bicycle out of a minivan unassisted, playing with a dog, driving a car, and twisting his neck. Citizens’ motion argued that plaintiff made material misrepresentations to Citizens regarding the extent of his injuries, which rendered him ineligible for benefits. The trial court found that, based upon the evidence presented, plaintiff failed to establish that he sustained a serious impairment of body function and therefore summary disposition in favor of Pugh was appropriate. THRESHOLD INJURY Plaintiff argued that the trial court erred by granting summary disposition in favor of Pugh. Under the no fault statute, the threshold question of whether the person has suffered a serious impairment of body function should be determined by the court as a matter of law as long as there is no factual dispute regarding the nature and extent of the person’s injuries that is material to determining whether the threshold standards are met. Plaintiff was obligated to respond to Pugh’s motion in order to meet his burden of demonstrating that a fact question existed as to whether he suffered a serious impairment of body function. The parts of plaintiff’s deposition identified by Pugh do not establish a genuine issue of material fact as to whether he suffered a serious impairment of body function. The relevant portions of plaintiff’s deposition testimony fail to rebut the evidence and instead set forth, at best, mere subjective complaints of pain. FRAUDULENT INSURANCE ACT The fraud statute finds that a person who presents or causes or to be presented an oral or written statement knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act under that is subject to the penalties imposed under the statute. A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment of PIP benefits. An individual commits a “fraudulent insurance act” when: (1) the person presents or causes to be presented an oral or written statement, (2) the statement is part of or in support of a claim for no-fault benefits, and (3) the claim for benefits was submitted to the MAIPF. Further, (4) the person must have known that the statement contained false information, and (5) the statement concerned a fact or thing material to the claim. ZIFL OPINION The evidence presented by the defendants were damning since they established the injuries claimed were false. Plaintiff failed to respond to the motions to his detriment and sought reconsideration without any admissible evidence that he was truly injured. The defendants established that the Plaintiff committed fraud and he is lucky that this was a civil finding not a criminal proceeding that, in my opinion, should be presented by the prosecutor. More McClenny Moseley & Associates Issues This is ZIFL’s thirty 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 may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. Health Insurance Fraud Convictions Pharmacist and Brother Convicted of $15M Medicare, Medicaid, and Private Insurer Fraud Scheme Raad Kouza, a pharmacist in Wayne County, Michigan, and his brother, Ramis Kouza, of Oakland County, Michigan, billed Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for prescription medications that they did not dispense at pharmacies they owned or operated in Michigan. A federal jury convicted the pharmacy owner and his brother November 8, 2024 for conspiracy to commit health care fraud and wire fraud. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Indicators of Bad Faith Set Up Some of the more common red flags of a bad faith set-up include the following: The claimant makes a policy limits settlement demand quickly after an accident, thereby depriving the insurer of the ability to conduct a full investigation. Quick demands that are combined with a limited amount of time to accept, again, in the hopes that records cannot be obtained and the investigation cannot be completed within that limited time period, and the settlement will be refused. The claimant makes a settlement offer with one or more unusual acceptance conditions. The involvement of the claimant’s counsel pre-dates certain medical or psychiatric care (e.g., testing and treatment for alleged mild traumatic brain injury) Read the full article and the full issue of ZIFL at http://https//zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024.pdf Convictions of Other Than Health Insurance Fraud Star in Reality TV Series Pleads Guilty Crop Insurance Fraud Steve A. McBee, 52, waived his right to a grand jury and pleaded guilty to a federal information that charges him with one count of federal crop insurance fraud. McBee, a Missouri farmer who appears in a reality TV show about his family’s farming operation pleaded guilty this week to a multi-million dollar fraud scheme involving federal crop insurance benefits. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Chutzpah – STOLI Fraudster Claims Hardship Felon Seeks Release from Home Confinement in Luxury Apartment in New York City Insurance Fraud is a serious crime, especially when it takes advantage of the elderly to defraud insurers in a Stranger Originated Life Insurance (STOLI) scheme. In United States Of America v. Michael Binday, No. 12 CR 152 (CM), United States District Court, S.D. New York (November 4, 2024) the defendant continued to use the wealth he gained from his fraud to impose on the courts of the United States with frivolous and unfounded motions. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Barry Zalma, Esq., CFE Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
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