Zalma’s Insurance Fraud Letter – November 1, 2024 ZIFL – Volume 28 Number 21 Posted on November 1, 2024 by Barry Zalma Post 4924 See the full video at and at Subscribe to ZIFL at https://visitor.r20.constantcontact.com/manage/optin?v=001Gb86hroKqEYVdo-PWnMUkcitKvwMc3HNWiyrn6jw8ERzpnmgU_oNjTrm1U1YGZ7_ay4AZ7_mCLQBKsXokYWFyD_Xo_zMFYUMovVTCgTAs7liC1eR4LsDBrk2zBNDMBPp7Bq0VeAA-SNvk6xgrgl8dNR0BjCMTm_gE7bAycDEHwRXFAoyVjSABkXPPaG2Jb3SEvkeZXRXPDs%3D The Source for the Insurance Fraud Professional Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ This issue contains the following articles about insurance fraud: Pill Mill Doctor’s Conviction Affirmed HEALTH CARE FRAUD CONVICTION AFFIRMED ACTING AS A DR. FEEL GOOD IS A FEDERAL CRIME According to the Sixth Circuit Dr. David Jankowski’s medical clinics relied on several unusual billing and prescription practices, many of which were illegal and Jankowski fraudulently billed Medicare for services he did not provide and prescribed controlled substances to patients whose conditions did not call for such treatment, with some patients unlawfully trafficking their prescribed drugs. In United States Of America v. David Jankowski, M.D., No. 23-1404, United States Court of Appeals, Sixth Circuit (October 23, 2024) the Sixth Circuit disposed of the fraudsters claims on appeal. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf More McClenny Moseley & Associates Issues This is ZIFL’s thirty sixth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. 10/24/2024 MMA BANKRUPTCY HEARING TO DECIDE WHETHER TRUSTEE WILL BE APPOINTED Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Injured While Drunk on the Job Gets Workers’ Compensation Benefits An appellate court in New York has upheld a decision of the Workers’ Compensation Board in favor of an injured employee of an electrical contractor company because intoxication was not the sole cause of the accident. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Man Bites Dog Story: Fraudsters Arbitration Attempts Stopped Arbitration Stayed for Suspected Chiropractors’ Fraudulent No Fault Medical Claims Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf In Government Employees Insurance Company, (“GEICO”) v. Didier Demesmin, M.D., et al, No. 23-CV-6191 (ARR) (MMH), United States District Court, E.D. New York (October 23, 2024) GEICO sought to enjoin defendants Manuel A. Mendoza, D.C. and Mendoza Chiropractic Office PC (collectively the “Mendoza Defendants”) from pursuing certain “no-fault” insurance collection arbitrations or initiating new collections proceedings during the pendency of this lawsuit. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Health Insurance Fraud Convictions Louisiana Nursing Home Owner to Pay $8.2M for Misusing Assets During Ida Bob Dean Jr a Louisiana nursing home owner and several companies he operated have agreed to an $8.2 million consent judgment to resolve allegations that they misappropriated and misused the assets and income of four nursing homes in Louisiana before and after Hurricane Ida’s landfall in August 2021. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Officer Caught Aiding Criminals for Cash Police Officer who took Bribes from Insurance Fraudster Convicted Demarkco Johnson (“Johnson”), appealed his convictions for taking bribes about insurance fraud. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf Convictions of Other Than Health Insurance Fraud Former Lake Forest Agent Convicted On 90 Counts Of Insurance Fraud After Stealing Nearly $200,000 In Premium Payments Karen Marie Dondanville, 56, of Mission Viejo, California, a former Lake Forest insurance agent was convicted on 90 counts of insurance fraud after stealing nearly $200,000 in premium payments. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf The Need to Understand the Mutability of Memory Investigators and lawyers believe what they are told by eye witnesses who describe what he or she says with conviction. However, every professional investigator or litigator must know that memory is not necessarily accurate because very few people have a perfect eidetic (photographic) memory. Memory is a fluid and often unreliable human function. Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf 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. Go to the podcast Zalma On Insurance at https://podcasters.spotify.com/pod/show/barry-zalma/support; Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog. Go to Zalma’s Insurance Fraud Letter at https://zalma.com/zalmas-insurance-fraud-letter-2/; Go to X @bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ and GTTR at https://gettr.com/@zalma Read the full article and all 18 pages of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/10/ZIFL-11-01-2024.pdf

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Man Bites Dog Story: Fraudsters Arbitration Attempts Stopped Arbitration Stayed for Suspected Chiropractors’ Fraudulent No Fault Medical Claims Post 4921 Read the full article at https://www.linkedin.com/pulse/man-bites-dog-story-fraudsters-arbitration-attempts-zalma-esq-cfe-5yw6c, see the full video at and at and at https://zalma.com/blog. In Government Employees Insurance Company, (“GEICO”) v. Didier Demesmin, M.D., et al, No. 23-CV-6191 (ARR) (MMH), United States District Court, E.D. New York (October 23, 2024) GEICO sought to enjoin defendants Manuel A. Mendoza, D.C. and Mendoza Chiropractic Office PC (collectively the “Mendoza Defendants”) from pursuing certain “no-fault” insurance collection arbitrations or initiating new collections proceedings during the pendency of this lawsuit. BACKGROUND GEICO provides personal injury protection benefits on a “no-fault” basis, which means that, after an accident, insured drivers and their passengers are entitled to certain benefits for medically necessary healthcare services regardless of who was at fault. GEICO sued a group of healthcare providers who allegedly carried out an insurance scheme to obtain fraudulent no-fault benefit payments from GEICO. The USDC granted the motion based on its conclusion that (1) GEICO would experience irreparable harm absent a stay, (2) GEICO raised a serious question going to the merits, and (3) the balance of hardships tipped in GEICO’s favor. Subsequently, GEICO requested leave to file a second amended complaint to add allegations concerning the Mendoza defendants which was granted. In total, GEICO seeks recovery of more than $5.9 million in wrongfully obtained benefits payments from the three groups of defendants, as well as a declaration that it is not obligated to reimburse defendants for outstanding no-fault claims. After filing the second amended complaint, GEICO filed the present motion seeking an order staying all pending no-fault benefits arbitrations between GEICO and the Mendoza defendants and enjoining the Mendoza defendants from commencing new collections proceedings during the pendency of this action. DISCUSSION GEICO Will Experience Irreparable Harm Absent A Stay. Irreparable harm is certain and imminent harm for which a monetary award does not adequately compensate. the risk of inconsistent judgments in no-fault insurance disputes can constitute irreparable harm separate and apart from the expenditure of time and money spent on parallel proceedings. As with the parallel proceedings brought by the Demesmin and Khanan defendants, the risk of inconsistent outcomes is great enough to establish irreparable harm. GEICO established irreparable harm because permitting arbitrations to proceed will subject it to a risk of judgments that may be inconsistent with future judicial rulings. GEICO Has Shown At Least Some Serious Questions Going To The Merits, And The Balance Of Hardships Tips In Its Favor. GEICO’s amended complaint details a complex scheme of fraudulent billing and referrals among a network of chiropractic providers. GEICO’s allegations concerning the Mendoza defendants’ role are well developed through numerous examples of charges billed without proper documentation or under suspicious circumstances and a table of more than 45,000 suspect claims. The balance of hardships also tips in GEICO’s favor because the Mendoza defendants have not established any hardship, beyond a delay in reimbursement. Because the defendants will presumably be entitled to collect interest on their pending claims if they prevail, the delay does not outweigh the risk of inconsistent outcomes faced by GEICO. A Stay Does Not Violate The Anti-Injunction Act. The Anti-Injunction Act (“AIA”) prohibits federal courts from enjoining proceedings in state court “except as expressly authorized by Act of Congress, or where necessary in aid of its jurisdiction, or to protect or effectuate its judgments.” 28 U.S.C. § 2283. The AIA does not, however, limit the court’s authority to enjoin ongoing private arbitration proceedings or the court’s authority to enjoin defendants from initiating future state court proceedings. GEICO’s motion was granted and a preliminary injunction was issued: staying all pending no-fault insurance collection arbitrations that have been Commenced against GEICO by or on behalf of the Mendoza defendants, pending the disposition of GEICO’s claims in this action, and enjoining the Mendoza defendants and anyone acting on their behalf from commencing new no-fault arbitrations and litigations against GEICO pending the disposition of GEICO’s claims in this action. ZALMA OPINION The USDC, and other courts dealing with No-Fault auto insurance claims, has acted to help insurers defeat attempted insurance fraud – a crime in each state like New Jersey – which became necessary because state prosecutors seemed to ignore the crimes reported to them by insurers like GEICO. It is essential that insurers be proactive against fraud to shame the insurance fraud investigators in each state to do their job and prosecute the fraud perpetrators. Every insurer, faced with such fraud, should emulate GEICO. (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

"The Harris-Walz-Obama 2.0 team had to contort and edit, cherry-picked soundbites into shapes that origami experts would envy to arrive at the current disingenuous narrative..." ORIGINAL CONTENT: https://www.undergroundusa.com/p/enemies-foreign-and-domestic READ, SUBSCRIBE, SHARE & EDUCATE: PROTECT FREE SPEECH #FifthColumn #USMilitary #NationalGuard #AmericanFifthColumn #Government #Biden #Harris #Marxism #Election2024 #Election #Disinformation #Media #MAGA #GOP #Podcast #Constitution #USA #Woke #Democrats #Politics #News #Truth

"The Harris-Walz-Obama 2.0 team had to contort and edit, cherry-picked soundbites into shapes that origami experts would envy to arrive at the current disingenuous narrative..." ORIGINAL CONTENT: https://www.undergroundusa.com/p/enemies-foreign-and-domestic READ, SUBSCRIBE, SHARE & EDUCATE: PROTECT FREE SPEECH #FifthColumn #USMilitary #NationalGuard #AmericanFifthColumn #Government #Biden #Harris #Marxism #Election2024 #Election #Disinformation #Media #MAGA #GOP #Podcast #Constitution #USA #Woke #Democrats #Politics #News #Truth

"The Harris-Walz-Obama 2.0 team had to contort and edit, cherry-picked soundbites into shapes that origami experts would envy to arrive at the current disingenuous narrative..." ORIGINAL CONTENT: https://www.undergroundusa.com/p/enemies-foreign-and-domestic READ, SUBSCRIBE, SHARE & EDUCATE: PROTECT FREE SPEECH #FifthColumn #USMilitary #NationalGuard #AmericanFifthColumn #Government #Biden #Harris #Marxism #Election2024 #Election #Disinformation #Media #MAGA #GOP #Podcast #Constitution #USA #Woke #Democrats #Politics #News #Truth

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Illegal Alien Bites Face of Border Patrol Agent on ‘Cartel Mountain’ https://www.infowars.com/posts/illegal-alien-bites-face-of-border-patrol-agent-on-cartel-mountain

I Get 20 Tick Bites Every Week (Lyme Disease) https://www.youtube.com/watch?v=5KSi-yCa4hE&list=TLPQMDgwOTIwMjRCwXcLEFFq1A&index=18

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