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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.

Chutzpah – STOLI Fraudster Claims Hardship Felon Seeks Release from Home Confinement in Luxury Apartment in New York City Post 4931 Read the full article at https://www.linkedin.com/pulse/chutzpah-stoli-fraudster-claims-hardship-barry-zalma-esq-cfe-8jbhc, see the full video at and at and https://zalma.com/blog plus more than 4900 posts. 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. BACKGROUND Michael Binday was sentenced to 144 months’ imprisonment after being found guilty of conspiracy to commit mail and wire fraud, as well as actual mail and wire fraud. The evidence at trial established that Binday led his codefendants in a scheme designed to procure “stranger-originated life insurance” (or “STOLI”) policies-policies on the lives of seniors for the benefit of investors who were strangers to them- by means of fraudulent applications. Binday spent the first five years of his sentence at FCI Otisville. But in September 2021, during the height of the COVID-19 Pandemic, the Bureau of Prisons released Binday to serve his sentence on home confinement. Thus, Binday has spent the last three-plus years serving his sentence in his luxury apartment on the upper westside of Manhattan. His sentence is scheduled to end on September 20, 2025. Binday filed: (1) a motion for compassionate release and (2) a motion pursuant to Rule 60(b) of the Federal Rules of Civil Procedure seeking to vacate the judgement of this Court dated May 23, 2018, denying his first petition. Michael Binday and his two codefendants, James Kergil and Mark Resnick, were found guilty of conspiracy to commit mail and wire fraud; mail fraud; and wire fraud in connection with a scheme to defraud insurance companies which the defendants purported to serve as agents. Binday led his codefendants in a scheme designed to procure “stranger-originated life insurance” (or “STOLI”) policies-policies on the lives of seniors for the benefit of investors who were strangers to them- by means of fraudulent applications. Over the course of their scheme, the defendants submitted at least 92 fraudulent applications, resulting in the issuance of 74 policies with a total face value of over $100 million. These policies generated roughly $11.7 million in commissions to the defendants. Binday was sentenced to 144 months’ imprisonment. BINDAY SURRENDERS Binday surrendered on July 1,2016, to FCI Otisville to commence his term of imprisonment and immediately filed motions for compassionate release, reversal of his convictions, and multiple other motions. On July 1, 2024, Binday-who is serving his sentence in his Manhattan apartment- filed a renewed motion for compassionate release. Binday Failed to Demonstrate Extraordinary and Compelling Circumstances As a threshold matter, it is worth emphasizing that Binday is not asking to be released from prison, but rather, to be relieved of the inconveniences associated with the rules of home confinement. He has served the last 38 months in his apartment on the upper west side of Manhattan (not at all what the Court intended when he was sentenced). How much more inconvenient it would be if he were back at Otisville- where the Court intended that he would serve his sentence. Binday’s crimes were serious. As the court explained when he was sentenced to 144 months in prison: Venality, rampant mendacity, the creation of false documents, obstruction of efforts by the victims to ascertain the truth, obstruction of regulators and the government’s efforts to learn the truth, Binday’s actions were precisely the sort of criminality that has left large segments of our society convince that all businessmen are crooks. Insurance fraud may not qualify as a crime of violence within the meaning of the federal sentencing system and that, unfortunately, is why it is all too often punished not with the severity that it deserves. As it is, Binday’s home confinement means that he is subject to far less stringent conditions than he would be otherwise. In that regard, he got more of a break than he deserves. The motion for compassionate release was denied. ZALMA OPINION STOLI fraud is a type of fraud on insurers that effects the straw buyers, usually older men and women who have no need for life insurance, is a truly venal act that deserves serious punishment. Binday stole millions from insurers, owns a luxury apartment in the Upper West Side of New York, and wants to be released from the confinement when he should have stayed in federal prison. He has abused the courts with his multiple motions and appeals and will serve out the remainder of his sentence and the DOJ and FBI should look into his current conduct since there is, in my opinion, the possibility that he is funding his attorneys fees with more 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 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

"One of the biggest benefits of a consumption-based tax system is that it is fundamentally equitable. Higher taxes on luxury goods would ensure the wealthy pay more in proportion to their consumption. Meanwhile, the average Joe would be equitably taxed on his Honda purchase..." ORIGINAL CONTENT: https://www.undergroundusa.com/p/trumps-income-tax-replacement-thought READ, SUBSCRIBE, SHARE & EDUCATE: PROTECT FREE SPEECH #Trump #Tariffs #Taxes #VAT #ConsumptionTax #IncomeTax #IRS #Harris #DeepState #AmericanFifthColumn #Government #Biden #Marxism #Election2024 #Election #Trump #Disinformation #Media #MAGA #GOP #Podcast #Constitution #USA #Woke #Democrats #Politics #News #Truth

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Inside the World's Largest Doomsday Bunker Community An Epic Humanitarian Project the size Of A city: 575 private bunkers with space for thousands in one of North America's safest locations: The decommissioned US Army Black Hills Ordnance Depot at Igloo, South Dakota; south of Edgemont, SD. Mankind has a continuing obsession with end of the world prophecies and judgement day. Any visible or invisible threat to life kicks our survival instincts into gear and we want to take action. The market capitalizes on this fear and pushes innovation and products that both feed and satisfy survivalism. I visited the Terra Vivos survival shelters in South Dakota last month. This former US Army Base was constructed in 1942 and was called the Black Hills Ordnance Depot. It served as an explosives and munitions storage and maintenance facility. The bunkers measure 27 feet in width and 60 to 80 feet in length. The foundation is made of 2 to 3 feet of reinforced concrete. The walls are 12 inches thick and have a trench running down the sides. The interior space is 13 feet tall at their highest point. This entire survival shelter project is headed by Robert Vicino who has a background in manufacturing and real estate. His son, Dante Vicino gave us a tour of the Terra Vivos site and took us to some unfinished and completed bunkers. The bunkers are completely off the grid. To make them livable, you have to consider 4 main utilities. Water, Sewage, Energy, Internet Access. They are structurally sound, so you don’t have to add any additional support or reinforcement. Soil in the area is stable unlike the clayey soil in Texas, so most of the 82 year old foundations are in great shape and don't have any cracks. The curved interior walls are made of board-formed concrete. You can still see the beautiful wood grain etched into the concrete. Working remotely is no longer an issue. Thermal mass of the 12 inch thick concrete walls store heat or thermal energy during the day and slowly release it at night when it’s cooler. It can be turned into a self-sufficient town with a supermarket, hardware store, bars and restaurants. I see a lot of similarities to Marfa which is a small desert city in West Texas. Marfa was also a military town in the 1940s but it was converted into a cultural hub by Donald Judd, a minimalist artist from New York City. It’s an over-ambitious plan. Out of the 800 bunkers on site, the Vivos company wants to convert 575 of them. So far, only 50 have been purchased. The lease plan prevents you from ever owning your bunker. The wildlife like cows and deer that roam the site often climb on top of the bunkers causing erosion of the soil and grass, and exposing the concrete. Since it’s not “underground” it’s not as safe as other survival shelters that are buried 3 to 10 feet underground. The company is catering to a small group of people. They warn of nuclear war, bioterrorism, anarchy, electro-magnetic pulses, solar flares, super volcanoes, etc. If they marketed their bunkers as a way to protect family, life and belongings, it might be more popular with a larger group of people. Remote location. In the event of a disaster, you’d need a private plane to take you to Provo, South Dakota. It only works as a survival shelter if you are permanently living there. The nearest hardware store is in Hot Springs, about 45 minutes to an hour away. Vicino’s contractors designed layouts, but I wasn’t impressed with the quality of their work. Contamination of the subsurface soil and water supply is a concern to some residents in the area. Long term effects of living in a concrete box with no sunlight are also problematic. It’s an exciting project with a lot of potential if a significant number of individuals move to the area. I don’t know what category these bunkers fit into. It’s not a luxury survival shelter, it’s not in a super-secure, secret location, it’s not conveniently located near a major city unless you consider Rapid City a major city; and it’s not underground. At best, it is an earth sheltered home or bungalow. I’m wary of it turning into a thriving community, unless their marketing strategy changes. https://rumble.com/v5gidwh-inside-the-worlds-largest-doomsday-bunker-community.html

PREACHES TO THE MIDDLE CLASS WHILE LIVING IN LUXURY.. STFU

EUROPE Rescuers were on Monday searching for six people missing after a luxury yacht was hit by a tornado and sank off the coast of Sicily, killing one of the 22 people on board. The vessel was hit by the tornado at around 5 a.m. Monday, according to a spokesperson for Italy’s Coast Guard.

https://thewashingtonstandard.com/tim-walzs-250m-state-program-to-feed-hungry-kids-fraudulently-spent-on-luxury-goods-fancy-cars-overseas-real-estate/