Inadequate Litigant’s Cases Dismissed Plaintiff, by her Litigation Appears to Establish the Report for a Mental Health Evaluation Was Appropriate Read the full article at https://lnkd.in/gECRyZ-f, see the full video at https://lnkd.in/gs_4Bby9 and at https://lnkd.in/g67dDK8q, and https://zalma.com/blog plus more than 4950 posts. Post 4950 In Samreen Riaz v. State Of California, et al., F087504, California Court of Appeals, Fifth District (December 2, 2024) the California Court of Appeals found itself asked to resolve suits against an individual and the state of California from an inadequate but excessively litigious plaintiff. FACTS Samreen Riaz was a licensed dentist – she lost her license to practice because of the facts underlying this case. According to her, there is an elaborate conspiracy to harass, stalk, threaten, and ultimately prevent her from testifying in a separate “whistleblower” case involving “OSHA and HIPPA Violations” at a medical facility. Riaz sued raising numerous claims against numerous individuals and government entities. The opposing parties challenged the complaint’s viability through demurrer and anti-SLAPP proceedings. The trial court sustained the demurrers and granted the anti-SLAPP motion, leaving Riaz with no viable claim. Riaz appealed. BACKGROUND The facts underlying this case involve four discrete events. First: Riaz sued a medical facility and suffered an alleged eye injury while attempting to testify in that case. Second: She sought treatment for that eye injury but was refused service and then sued that doctor in small claims court. Third: That doctor reported Riaz to the Dental Board of California which, in turn, initiated mental health competence proceedings against Riaz. Fourth: Riaz’s license to practice dentistry was revoked, and she filed the complaint at issue in this case. Initial Lawsuit Against Medical Facility Acting as a “whistleblower,” Riaz “disclosed … OSHA, Hippa, recruited patient, potential insurance fraud and anti-competent activities in the market” at a medical facility. After filing a lawsuit on that basis, Riaz claimed she suffered “organized harassment,” culminating in “permanent eye damage” after a sheriff-department employee pointed a finger in her face while attempting to enter the courthouse in her “whistleblower” case. Visiting Doctor for Eye Injury Riaz visited Dr. Cantrell to treat an eye injury. She claimed Cantrell became combative, refused to answer Riaz’s questions, and declined to treat Riaz. The next day, Riaz filed a complaint with the Medical Board of California. Several days later, she filed a small claims case against Cantrell, essentially alleging discrimination, negligence, and retaliation. A small claims judgment was eventually entered in Cantrell’s favor. Report to Dental Board Cantrell reported Riaz to the Dental Board. The Dental Board issued an order to Riaz to comply with a mental health examination “to evaluate her fitness to practice safely ….” (See Bus. &Prof. Code, § 820.) Riaz failed to comply with the order. Since Riaz continued to disobey the order, her license to practice dentistry was ultimately revoked. Instant Complaint and Judgment Riaz sued Cantrell, various government entities, and several individuals working for those entities (collectively, the State). The complaint alleged an elaborate conspiracy among all the defendants to injure Riaz, to intimidate her to prevent her from testifying, and to retaliate against her for the “whistleblower” case. The trial court sustained the demurrers and granted the anti-SLAPP motion resulting in total dismissal. DISCUSSION Did the trial court err in granting the anti-SLAPP motion? Did it err in sustaining the demurrers? The California Court of Appeals concluded the trial court did not err. Anti-SLAPP Motion In the anti-SLAPP motion, Cantrell argued his furnishing information to the Dental Board was protected activity and defeated claims “for discrimination, fraud, defamation, retaliation[,] and intentional infliction of emotional distress[.]” In opposition to the anti-SLAPP motion, Riaz claimed again Cantrell “made inaccurate, knowingly misleading statements to the [D]ental [B]oard to defame and harm [Riaz] based on disclosing patient information.” The trial court concluded furnishing those documents to the board constituted protected activity. ANALYSIS Litigation of an anti-SLAPP motion involves a two-step process. First, the moving defendant bears the burden of establishing that the challenged allegations or claims that arise from protected activity in which the defendant has engaged. Second, for each claim that does arise from protected activity, the plaintiff must show the claim has at least minimal merit. If the plaintiff cannot make this showing, the court will, and did, strike the claim. If there is no merit, the claim is stricken. The Court of Appeals noted that Riaz failed to adduce any evidence-including exhibits, declarations, judicial notice, and testimony-to substantiate her allegation Cantrell reported her to the Dental Board for retribution. She failed to adduce admissible evidence on the point. DEMURRERS Both Cantrell and the State filed demurrers to Riaz’s complaint.. Additional Background A small claims plaintiff is collaterally estopped from relitigating the same issue in superior court where the record is sufficiently clear to determine that the issue was litigated and decided against plaintiff in the small claims action. Governmental immunity is an affirmative defense properly raised by demurrer. Government Code section 821.6 immunizes public employees from liability for ‘instituting or prosecuting any judicial or administrative proceeding’ within the scope of their employment, even if the employees act ‘maliciously and without probable cause. Riaz alleged her claims arose in July 2022. Her written government claim was submitted in April 2023, more than six months later. Accordingly, the claims were barred, at least insofar as they stemmed from the section 820 order. CONCLUSION AND SUMMARY Riaz failed to allege colorable claims against either Cantrell or the State. The potential claims against Cantrell were either tried and resolved against her in small claims court or dismissed pursuant to the anti-SLAPP statute. The potential claims against the State were either barred for failure to timely present them under the Government Claims Act, or the State was immune under Government Code sections 821.6, 818.4, and 821.2. ZALMA OPINION It is axiomatic that a person who represents himself has a fool for a client. The litigation history, the multiple actions, and the lack of consistency and evidence, establish that Dr. Cantrell was correct when he advised the Dental Board that a mental health examination to evaluate her fitness to practice safely…” was correct. She refused to fulfill her obligation to the Dental Board to be evaluated because she was concerned she would not pass. This case is an abuse of Doctor Cantrell and the state and should have resulted in serious sanctions. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

Intent to Move is not a Residence Residence Premises Requires the Insured to Live in Residence Post 4944 Read the full article at https://www.linkedin.com/pulse/intent-move-residence-barry-zalma-esq-cfe-qmlxc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. In Paul Villalobos v. Clear Blue Insurance Company, No. 24-20125, United States Court of Appeals, Fifth Circuit (December 10, 2024) the the Fifth Circuit affirmed the district court’s dismissa of Plaintiff-Appellant Paul Villalobos’s breach of contract claim following a coverage dispute between himself and his insurer, Clear Blue Insurance Company, because he admitted he did not live in the insured premises. FACTS Villalobos is named on a Clear Blue homeowners’ policy, which provides coverage for property located at 7503 Muirwood Lane in Houston, Texas (the “Property”). The policy’s “Property Coverages” section states in pertinent part: “We cover . . . [t]he dwelling on the ‘residence premises’ shown in the Declarations.” The policy defines “residence premises,” also in pertinent part, as “[t]he one-family dwelling where you reside . . . on the inception date of the policy period shown in the Declarations.” The Declarations page lists Villalobos as the insured, his mailing address as the Property, and the inception date as September 21, 2021. In mid-November 2021, Villalobos reported to Clear Blue that wind and hail had damaged the Property’s roof earlier that month. Clear Blue denied coverage after Villalobos admitted he lived in Colorado and had never resided at the Property. Villalobos sued Clear Blue, alleging breach of contract, breach of the duty of good faith and fair dealing, violations of the Texas Deceptive Trade Practices Act and the Texas Insurance Code, fraud, and ongoing conspiracy to commit illegal acts. ANALYSIS During his deposition, Villalobos testified that he lived in Colorado for over nine years and did not reside at the Property when the Clear Blue policy went into effect. Clear Blue moved for summary judgment on Villalobos’s claims, arguing there was no insurance coverage for Villalobos’s property damage as a matter of law. Applying Louisiana law, the Fifth Circuit has previously determined that an identical residence requirement in a homeowners’ insurance policy required “more than purchasing a home or intending to move into it.” GeoVera Specialty Ins. Co. v. Joachin, 964 F.3d 390, 393 (5th Cir. 2020). Applying Joachin the Fifth Circuit agreed with the district court that the Property did not satisfy the policy’s residence requirement and was not a covered “residence premises” because: it is undisputed that Villalobos did not reside on the Property on the inception date of the Clear Blue policy; and Villalobos’s only material argument on appeal is that he intended to move onto the Property. Joachin held that “intending to move” is not enough. The Fifth Circuit concluded that there is no coverage under the policy. Accordingly, Villalobos’s breach of contract claim failed and the USDC’s judgment was affirmed. ZALMA OPINION That something as obvious as a home in Texas cannot be the residence premises of a person who lives full time in Colorado. Insurers issue property insurance policies providing coverage similar to a homeowners policy to the owner of a rental property while a homeowners policy limits coverage to the person who actually resides at the property. That this case went to the Fifth Circuit was the waste of Plaintiff’s time and money, the waste of the time of the trial court, and the waste of the time of the Fifth Circuit who rendered a concise and clear opinion. A less kind judge or appellate court would have imposed sanctions on the party plaintiff and his counsel. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

https://www.breitbart.com/middle-east/2024/12/10/biden-gave-iran-10-billion-in-sanctions-relief-days-after-trump-won-election/

China slaps sanctions on many US military firms after investigate arms sale and also F-16 jets and radars.

This Is How It Begins: The Deep State Wants to Terminate the Constitution. This is how it always begins, justified in the name of national security. We’ve allowed ourselves to be seduced by the false siren song of politicians promising safety in exchange for relinquished freedom. We placed our trust in political saviors and failed to ask questions to hold our representatives accountable to abiding by the Constitution. We looked the other way and made excuses while the government amassed an amazing amount of power over us, and backed up that power-grab with a terrifying amount of military might and weaponry, and got the courts to sanction their actions every step of the way. We chose to let partisan politics divide us and turn us into easy targets for the government’s oppression. https://www.rutherford.org/publications_resources/john_whiteheads_commentary/this_is_how_it_begins_the_deep_state_wants_to_terminate_the_constitution

“Your chance of dying from a heart attack from that ‘vaccine’…according to their own studies…is 500% greater…than if you were unvaccinated…” This is state-sanctioned murder.

Insurer Properly Sanctioned for Failure to Obey Court Order It is Never Proper to Fail to Comply With Court Order Post 4937 Read the full article at https://www.linkedin.com/pulse/insurer-properly-sanctioned-failure-obey-court-order-barry-vefvc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. Insurer Privilege Underwriters took its name too far trying to obtain privileges from the Arkansas Court of Appeals to which it was not entitled and acted contumaciously by disobeying the Circuit Court’s discovery order. In Privilege Underwriters Reciprocal Exchange v. Brandon Adams, No. CV-23-474, 2024 Ark.App. 571, Court of Appeals of Arkansas, Division I (November 20, 2024) the circuit court granted appellee Brandon Adams’s motion to enforce court order and motion for sanctions, imposed a “sanction fee in the amount of $5,000” against appellant Privilege Underwriters Reciprocal Exchange (“Privilege”), and awarded Adams $2,500 in attorneys’ fees and costs under Arkansas Rule of Civil Procedure 37; denied Privilege’s motion for summary judgment; and denied Privilege’s motion for protective order, which sought to bar Adams from taking any depositions. FACTS In an insurance-coverage action in which Adams sued Privilege, his insurer, for failing to provide him a defense in a lawsuit filed against Adams and several other individuals and entities. Privilege answered Adams’s coverage complaint denying that it owed Adams a duty to defend the lawsuit and asserting a number of the subject policies’ exclusions as affirmative defenses to coverage. Adams served written discovery on Privilege. Privilege responded with objections and inadequate responses to Adams’s discovery requests. Adams moved to compel Privilege to respond and produce documents and the Court of Appeals ordered Privilege respond and to pay Adams’s attorneys’ fees and costs in the amount of $2,000. Privilege produced its supplemental interrogatory answers and supplemental privilege log on March 2, 2022 but did not comply with the circuit court’s discovery order. Contrary to the court’s order Privilege refused to amend its privilege log, provide full and complete answers to Adams’s interrogatories, or produce any witnesses for deposition, and instead, Privilege moved for summary judgment. Adams then filed his “Motion to Enforce Court Order and Motion for Sanctions and Incorporated Brief” on April 25, 2022. On December 20, 2022, the circuit court held a hearing on Adams’s motion for sanctions and Privilege’s motions for summary judgment and for protective order. The circuit court announced that it would sanction Privilege for its failure to comply with the circuit court’s February 2022 discovery order. From the bench, the circuit court made specific findings that Privilege had failed to comply with the provisions of that order requiring Privilege to amend its privilege log to provide sufficient information to allow the circuit court and Adams to evaluate Privilege’s claims of attorney-client privilege and work-product protection and to fully answer Adams’s interrogatories. TO ESTABLISH CONTEMPT Generally, in order to establish contempt, there must be willful disobedience of a valid order of a court. Contempt is a matter between the court and the litigant, and not between the two opposing litigants. Before one can be held in contempt for violating the court’s order, the order must be definite in its terms, clear as to what duties it imposes, and express in its commands. Contempt is divided into criminal contempt and civil contempt. The standard of review on appeal depends on whether the contempt sanction was civil or criminal in nature. The circuit court imposed a fine and fees that were to be paid to Adams. A contempt fine for willful disobedience that is payable to the complainant is remedial and therefore constitutes a fine for civil contempt. Privilege refused to comply with a valid discovery order from the circuit court because Privilege disputed Adams’s entitlement to the discovery underlying that order. Instead, Privilege moved for summary judgment, attempting to render moot that prior discovery order. The circuit court rightly held Privilege in contempt for its willful disobedience of the circuit court’s February 2022 discovery order and imposed a fine of $5,000. Once the February 2022 discovery order was entered, Privilege was required to comply with that order, not question the propriety of that order or when Privilege should comply with it. The circuit court was unequivocal in finding at the December 2022 hearing that it was sanctioning Privilege for its violation of the February 2022 discovery order. The circuit court then went on to explain that Privilege had disobeyed its February 2022 order by failing to provide contact information for the witnesses identified in response to Interrogatory No. 1 and by failing to provide a privilege log with sufficient information to allow the circuit court and Adams to evaluate the claim of attorney-client privilege and work-product protection. Thus, the Court of Appeals held that the circuit court did not clearly err in holding Privilege in contempt. The circuit court had ample authority to use its contempt powers to enforce its February 2022 discovery order. ZALMA OPINION This order must be more than embarrassing to Privilege and to the insurance industry. Parties to litigation are not entitled to refuse to fulfill an order of the court. Regardless of the name of the insurer it had no special privileges and must fulfill the order to the letter and pay the sanctions including the extra sanctions placed by the Court of Appeals. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk

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.

Chiropractor Disciplined for Improper Billing Chiropractor Lies to Board and Loses Right to Practice Post 4930 Read the full article at https://www.linkedin.com/pulse/chiropractor-disciplined-improper-billing-barry-zalma-esq-cfe-4qjdc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. This appeal arises from an attempt by the state of Illinois to impose discipline upon plaintiff Christopher D. Leone, D.C., due to certain improper activities performed as a licensed chiropractor in the state of Illinois. In Christopher D. Leone, D.C. v. The Department Of Financial And Professional Regulation, Division Of Professional Regulation; and Cecilia Abundis, in Her Official Capacity as Acting Director of the Department of Financial and Professional Regulation, No. 4-22-0753, 2024 IL App (4th) 220753-U, Court of Appeals of Illinois, Fourth District (November 6, 2024) the Court of Appeal resolved the multiple claims of the chiropractor. BACKGROUND Leone has practiced as a chiropractor since 1999 and initially practiced in the state of Washington. The matter was resolved pursuant to an informal disposition via stipulation. Leone began practicing in Illinois in 2004, and in 2010 and a consent order was issued pursuant to which Leone admitted to the allegations and was reprimanded with a $5000 fine and a requirement that he undertake 20 hours of continuing education; 10 of those hours were to focus on Medicare billing and insurance coding and another 10 on record keeping. In 2013, the United States alleged that Leone “knowingly and fraudulently” submitted Medicare claims of less than $1000 for one-on-one physical therapy services that were not provided. Following negotiation, the parties entered into a plea agreement, pursuant to which Leone pleaded guilty to the one-count information and stipulated to a factual basis for his plea. Shortly after the Medicare fraud charge was filed against Leone, the State filed a five-count complaint alleging multiple violations of the Medical Practices Act of 1987 (Act). During the litigation, Leone applied to renew his chiropractic license. One of the questions on the application asked whether he had been convicted of any criminal offense, state or federal, since July 2011; Leone answered, “No,” failing to document the Medicare fraud conviction. Attempting to explain his federal guilty plea, Leone said that he was unable to modify the language in the plea agreement, as “the time for negotiations had run out” and the plea was a “take-it-or-leave-it” proposition. Leone read the plea agreement line by line and, although he claimed it contained false information, he signed it. ALJ Report and Recommendation The Administrative Law Judge (ALJ) issued his report and recommendation, finding that, pursuant to the guilty plea in the federal case, Leone had admitted that his patients performed physical therapy on their own without supervision. Also, Leone admitted in his plea that entries in patient records indicating that they received hands-on or one-on-one physical therapy were false. Further, the guilty plea established that Leone knowingly submitted claims to Medicare for services that he did not provide. Leone had also billed private insurers numerous times under the same code as Medicare. The conviction also established that he engaged in false billing and false entries in patient records. The ALJ recommended an indefinite suspension of Leone’s license for a minimum of two years. An expert testified that chiropractors who engaged in Medicare fraud violated several tenets of chiropractic ethics. There was a pattern of overcharging for services that were not provided, false notations in patient records to support the false charges, and the submission of false claims to insurance that went on for at least five years. Leone obtained fees by fraud, deceit, or misrepresentation, and those actions fell below the professional and ethical standards required of chiropractors in Illinois. Leone’s conduct, along with his past disciplinary history, “demonstrate[d] a pattern of behavior that [was] not acceptable.” ANALYSIS It was undisputed that Leone submitted charges under billing code 97110. Leone pled guilty to submitting a false demand for payment upon the United States. In his plea, Leone admitted to billing for services that were not actually provided to his patients as claimed, “and the instruments containing the demands for payment of public money, therefore were false when they were submitted” and “were submitted to Medicare with the knowledge that he did not perform the service charged.” The guilty plea supports the conclusion that Leone knowingly and intentionally submitted claims for reimbursement for services provided under code 97110 where the services did not meet the requirements to be paid under that code. This pattern went on for approximately five years, resulting in 1324 false claims in the amount of $93,900. The Department established a violation of the Act where Leone failed to note the federal conviction on his renewal application. Discipline A review of the initial circuit court order in this matter reveals that it merely recommended that the Department consider probation as a punishment; it did not make a ruling to that effect. There was no abuse of discretion in the discipline imposed. For the reasons stated, the Court reversed the circuit court’s judgment and affirm the Director’s decision. ZALMA OPINION Leone successfully committed fraud on the United States, the state of Illinois, and the insurance industry by falsely billing services he did not provide. He pleaded guilty to one count of Federal Health Insurance fraud and then lied to the state of Illinois when he applied to renew his license. With lawyers and retained experts he delayed the sanction for years. The Court of Appeals finally resolved the multiple disputes and applied an appropriate sanction and suspension of his license. He should consider himself lucky that he was not prosecuted criminally by the state and the US Government accepted his plea. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. 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Insurance Fraud Requires Doctor to Lose his License Read the full article at https://www.linkedin.com/pulse/insurance-fraud-requires-doctor-lose-his-license-zalma-esq-cfe-l2qkc/?trackingId=8KA%2FEXdvoGfzd13NxusOMw%3D%3D Sexual Misconduct, Fraud, Bribery & Unnecessary Surgery Revokes License Post 4927 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. ZALMA 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. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to X @bzalma; Go to the Insurance Claims Library – https://lnkd.in/gwEYk