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. 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

No Breach of Contract no Bad Faith Happy Veterans Day to My Fellow Veterans Some Claims Proper Some Not Read the full article at https://www.linkedin.com/pulse/happy-veterans-day-my-fellow-barry-zalma-esq-cfe-ovpec, shttps://www.linkedin.com/pulse/happy-veterans-day-my-fellow-barry-zalma-esq-cfe-ovpec and at https://zalma.com/blog plus more than 4900 posts. Post 4929 Vepo Design Corporation and its officers (collectively, “Vepo”) appealed the district court’s grant of summary judgment on their breach of contract and bad faith claims against American Economy Insurance Company (“AEIC”). Vepo’s claims relate to AEIC’s denial of coverage following a fire in a laundromat, known as the “Central Laundromat,” which Vepo was developing. In Vepo Design Corporation, et al. v. American Economy Insurance Company, No. 23-55634, United States Court of Appeals, Ninth Circuit (November 4, 2024) the issues were resolved serially. DECISIONS Business Income The Ninth Circuit reversed the district court’s grant of summary judgment in favor of AEIC on Vepo’s business income claim, which concerns income Vepo contends it would have earned operating the Central Laundromat if the fire had not occurred. AEIC argued that Vepo’s claim for lost income was too speculative given that the Central Laundromat was still under construction and Vepo had not secured additional financing to own and operate it. Construing the facts in the light most favorable to Vepo as the non-moving party the Ninth Circuit concluded that there is sufficient evidence to create a genuine dispute of material fact and that Vepo’s claim for lost business income is not unduly speculative. There is evidence that Vepo was contemplating an arrangement under which it would own and operate the Central Laundromat for a period of time before selling it, and that Vepo later engaged in similar arrangements for other laundromats. Vepo, which was experienced in the laundromat industry, also demonstrated that it had a history of securing financing for its laundromat projects and that it intended to refinance the Central Laundromat once a certificate of occupancy was received. Although Vepo had not secured refinancing for the Central Laundromat as of the time of the fire, Vepo’s Principal Owner stated in her declaration and confirmed at her deposition that it was too early to do so in the project timeline. That Vepo had yet to refinance does not render its claim too speculative as a matter of law and its losses are for a jury to decide. Extra Expense The Ninth Circuit affirmed the district court’s grant of summary judgment in favor of AEIC for the extra expenses that Vepo allegedly incurred in storing laundry equipment in a warehouse owned by Vepo’s sister company following the fire. While the policy only required the expense to be incurred, not paid, there was insufficient evidence to create a triable issue over whether the expense was incurred at all. No payment changed hands between the two entities, and there is no accounting record showing that Vepo was liable for the storage amount. When the same person signed as representative of both entities, does not create a genuine dispute of material fact. Lost Profits The Ninth Circuit concluded that the district court properly granted summary judgment on Vepo’s claim for lost profits on the prospective sale of the laundromat. Even assuming that such a loss would be covered under the policy, the claim fails because the policy limited coverage to losses that occur within one year of the incident. Vepo’s plan called for it to own and operate the Central Laundromat for at least one year after opening, which would place any hypothetical sale more than a year after the pre-opening fire. Individual Personal Property Claims The Ninth Circuit affirmed summary judgment for AEIC on the claims by the individual plaintiffs for their own personal property that was allegedly lost in the fire. As the district court correctly found, Vepo did not identify what individual property was lost or its worth. The individual plaintiffs’ claims were too unsupported to create a triable issue. Bad Faith The Ninth Circuit partially reversed the district court’s grant of summary judgment on Vepo’s bad faith claim, to the extent of the single insurance claim it allowed to go forward-the business income claim. The district court may permit any further motions practice on the bad faith claim as it deems appropriate. However, it affirmed the district court’s grant of summary judgment on the bad faith claim insofar as that claim is premised on any of the other breach of contract claims to which AEIC is entitled to judgment as a matter of law. There is never a claim for breach of the implied duty of good faith and fair dealing if there was no improper denial of coverage under the policy. ZALMA OPINION The importance of this case is the reiteration of the law that there can never be a viable tort of bad faith if there is no improper denial of a claim by breach of the insurance contract. If the one cause of action remaining was breached in bad faith and there was no genuine dispute over coverage, that cause can be brought for bad faith damages. The other decisions of the Ninth Circuit were obvious and well reasoned. (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

Trump Plan to FIX Censorship Industrial Complex https://johnhouk.substack.com/p/trump-plan-to-fix-censorship-industrial SUMMARY: On November 9 I ran into an X/Twitter post by MiddleMaga…m highlighting a video by duly elected President Trump who expressed his itinerary for handling the Censorship Industrial Complex….TAKE A LOOK! #CensorshipIndustrialComplex #CensorshipFix

They absolutely are! #Freemasonry influences and CONTROLS every "control structure" on earth! The Freemasons CONTROL the #Politicians, the #Police, and the #Courts! They also CONTROL big pharma and the medical industrial complex! They also CONTROL #Education and the #Schools! And the #Rothschild #Bankers control the Freemasons! Then Satan himself controls the Rothschilds! See how that works?

WATCH AND SHARE THIS VIDEO SERIES!!! It is a revealing look into the "medical industry" If you believe that doctors exists to keep you healthy.... You better THINK AGAIN! CULT OF THE MEDICS https://www.cultofthemedics.com/chapters.html

You know.... It still amazes me that everyone don't realize that #Trump is an ACTOR! Just like the rest of "government" ALL of them are employed by the Federal Reserve, "Corporation of the United States" and the military industrial complex, and some BANKERS at the #IMF The same people that employee these ACTORS print up unlimited worthless pieces of paper, known as the "Dollar," and they CONTROL ALL OF HUMANITY WITH THEM! We can trade using ANYTHING! WHY would we trade using something that keeps us enslaved? It just don't make good sense! I voted for him in 2016.... But I've awakened to the #Truth since then! Your "vote" is your CONSENT to be ruled by these people! https://youtu.be/vVeVcVBW_CE

We ALL live on the Jones Plantation! If you have not seen this film by Larken Rose then YOU NEED TO! This film PERFECTLY demonstrates our "system of government" Our illegitimate, #Satanic, and #Evil #Government (Which is a CORPORATION) "Our government is the entertainment division of the military industrial complex" A bunch of wizards who have brainwashed people into compliance, with ZERO legitimate "Authority" NOBODY has any say of who they install as President & CEO of the CORPORATION! They simply make you believe that it does. The "Money PRINTERS" over at the Federal Reserve and the World Banks run this show partner! Go and watch "The Jones Plantation" "Choosing who rules over you is not the same as being free" https://jonesplantationfilm.com/

IM SO GRATEFUL FOR THE WIN. MY QUESTION IS HOW IS TRUMP GOING TO BUILD OUR FARMS BACK WHEN THE DEMOCRATS HAVE DESTROYED OUR FOOD INDUSTRY. THEY ARE USING BIRD FLU LIKE THEY USED C19. WHEN WAS THE LAST TIME YOU SEE BIRDS FALLING. CHICKENS AND EGGS ALL YR BUT ONLY TURKEYS DURING NOV-DEC. PEOPLE, FARMERS ARE FED UP. WE CANT LIVE WITHOUT THEM.

Removing Big Pharma ads from fake media TV could result in a 75% loss of ad revenue for the industry. Achieve two goals at once. Dig two holes with one shovel.

The Vega star system is one of the most studied in astronomy due to its proximity, brightness, and unique characteristics that challenge our understanding of planet formation and stellar evolution. Located just 25 light-years away from Earth in the constellation Lyra, Vega is a blue-white star and the fifth-brightest star visible in our night sky. Here's a breakdown of the most intriguing features of the Vega system: 1. Dust Disk Discovery Infrared Excess: In the 1980s, the Infrared Astronomical Satellite (IRAS) discovered an excess of infrared radiation from Vega, indicating a dust disk around the star. This disk emits infrared radiation as dust particles are heated by Vega's light, suggesting an early model of a protoplanetary or debris disk. Smooth Disk: Unlike other systems like Fomalhaut, Vega’s disk is remarkably smooth, lacking the gaps and rings typically associated with planets disturbing the dust. This smoothness implies that Vega may lack substantial planetary influences or that planets there may be few and more challenging to detect. 2. Potential "Hot Neptune" Astronomers have hypothesized that Vega might host a hot Neptune—a large planet orbiting close to the star, with a mass similar to that of Uranus or Neptune. If present, this planet could slightly perturb the disk, though not enough to create the pronounced structures seen in other systems. 3. Asteroid Belt Analogy Collapse Observations suggest that Vega may contain a large asteroid belt similar to our Solar System's, with a spread-out disk of rocky material. This possible asteroid belt might add to the dust observed around Vega and could provide insights into the early formation phases of planetary systems. 4. Historical and Cultural Significance Former Pole Star: Around 14,000 years ago, Earth's axis pointed toward Vega, making it the northern pole star until approximately 12,000 BC. The star held great significance for ancient civilizations due to its prominence. Name and Mythology: The name "Vega," originally spelled "Wega," comes from the Arabic "Al Nasr al Waki," meaning "Swooping Eagle." Vega is a cornerstone of the Summer Triangle, a prominent asterism for northern hemisphere skywatchers, along with Altair and Deneb. 5. Milestones in Astronomy First Stellar Spectrum: Vega was the first star to have its spectrum recorded in 1850, helping astronomers study stellar composition and temperature. Early Photographic Milestone: It was also the second star, after the Sun, to be photographed, marking a major step in astronomical imaging. 6. Variable Star Characteristics Vega is classified as a Delta Scuti variable, with slight pulsations that cause small changes in its brightness over time. Although minimal, these fluctuations provide valuable data for stellar research and challenge Vega's historic role as a "constant" in brightness. 7. Future Research and Exploration With its dust disk and potential hot Neptune, Vega remains a prime target for studying alternative pathways in planetary system evolution. Optical spectroscopy allows astronomers to analyze parameters such as star formation rates and chemical composition, shedding light on the processes within Vega's disk and its potential for planet formation. 8. Vega's characteristics—its smooth disk, possible planetary companions, and cultural prominence—continue to intrigue astronomers. Future missions and telescopes may reveal more about this iconic star system, potentially uncovering planets or additional features that reshape our understanding of how stars and planetary systems evolve.