• Twitter thread … “Do you know how much your State sends to Israel annually? In 2023 the US signed a MOU w/Israel to guarantee $3.8 Billion in Federal aid per year til 2028, but how much does each of the 50 States pay Israel every year??

    Alabama: $54.8M, Alaska: $972 K, Arizona $355 M, Arkansas $53.7 M, California: $1.68 B, Colorado: $54.4 M, Connecticut: $232 M, Delaware: $15.2 M

    Florida: $461.5 M, Georgia: $389.2 M, Hawaii: $11,950, Idaho: $11 M, Illinois: $216.4 M, Indiana: $171.4 M, Iowa: $42 M, Kansas: 23.1 M

    Kentucky: $103.1 M, Louisiana: $102.6, Maine: $8.5 M, Maryland: $52.9 M, Massachusetts: $197.3 M Michigan: $242 M, Minnesota: $119.5 M, Mississippi $47 M

    Missouri: $240.3 M, Montana: $7.4 M, Nebraska: $59 M, Nevada: $56.2 M, New Hampshire: $108 M, New Jersey: $403 M, New Mexico: $13.8 M, New York: $4.8 B

    North Carolina: $158 M, North Dakota: $6.9 M, Ohio: $241.9 M, Oklahoma $83.8 M, Oregon: $947.1 M, Pennsylvania: $263.6 M, Rhode Island: $13.5 M, South Carolina: $126 M

    South Dakota: $7.5 M, Tennessee: $81 M, Texas: $845 M, Utah: $56.8 M, Vermont: $17.5 M, Virginia: $76 M, Washington: $228 M, West Virginia: $126 M, Wisconsin: $115.3 M, Wyoming: $716 K

    Federally the US gives $3.8 Billion annually to Israel. The States' give a whopping $13.6 Billion annually sent to Israel. This means the grand total of funds coming from the US [Fed+States] is $17,400,000,000.00 [$17.4B]”

    More photos in comments

    https://x.com/dezzie_rezzie/status/182852273295212…

    _______________

    RECEIPTS/SOURCES/LINKS

    U.S.-Israel Relations: States-to-State Cooperation
    HTTPS:/http://WWW.JEWISHVIRTUALLIBRARY.ORG/U-S-ISRAEL-COO…

    U.S. Aid to Israel in Four Charts
    https://www.cfr.org/article/us-aid-israel-four-cha…

    What Every American Should Know About U.S. Aid to Israel
    http://http://http://http://http://HTTPS://WWW.AJC…

    R.I. opposes discrimination against Israel
    https://www.providencejournal.com/story/opinion/20…
    Twitter thread … “Do you know how much your State sends to Israel annually? In 2023 the US signed a MOU w/Israel to guarantee $3.8 Billion in Federal aid per year til 2028, but how much does each of the 50 States pay Israel every year?? Alabama: $54.8M, Alaska: $972 K, Arizona $355 M, Arkansas $53.7 M, California: $1.68 B, Colorado: $54.4 M, Connecticut: $232 M, Delaware: $15.2 M Florida: $461.5 M, Georgia: $389.2 M, Hawaii: $11,950, Idaho: $11 M, Illinois: $216.4 M, Indiana: $171.4 M, Iowa: $42 M, Kansas: 23.1 M Kentucky: $103.1 M, Louisiana: $102.6, Maine: $8.5 M, Maryland: $52.9 M, Massachusetts: $197.3 M Michigan: $242 M, Minnesota: $119.5 M, Mississippi $47 M Missouri: $240.3 M, Montana: $7.4 M, Nebraska: $59 M, Nevada: $56.2 M, New Hampshire: $108 M, New Jersey: $403 M, New Mexico: $13.8 M, New York: $4.8 B North Carolina: $158 M, North Dakota: $6.9 M, Ohio: $241.9 M, Oklahoma $83.8 M, Oregon: $947.1 M, Pennsylvania: $263.6 M, Rhode Island: $13.5 M, South Carolina: $126 M South Dakota: $7.5 M, Tennessee: $81 M, Texas: $845 M, Utah: $56.8 M, Vermont: $17.5 M, Virginia: $76 M, Washington: $228 M, West Virginia: $126 M, Wisconsin: $115.3 M, Wyoming: $716 K Federally the US gives $3.8 Billion annually to Israel. The States' give a whopping $13.6 Billion annually sent to Israel. This means the grand total of funds coming from the US [Fed+States] is $17,400,000,000.00 [$17.4B]” More photos in comments https://x.com/dezzie_rezzie/status/182852273295212… _______________ RECEIPTS/SOURCES/LINKS U.S.-Israel Relations: States-to-State Cooperation HTTPS:/http://WWW.JEWISHVIRTUALLIBRARY.ORG/U-S-ISRAEL-COO… U.S. Aid to Israel in Four Charts https://www.cfr.org/article/us-aid-israel-four-cha… What Every American Should Know About U.S. Aid to Israel http://http://http://http://http://HTTPS://WWW.AJC… R.I. opposes discrimination against Israel https://www.providencejournal.com/story/opinion/20…
    0 Comments 0 Shares 352 Views

  • Lose if You Fail to Respond to Motion for Summary Disposition

    INSURERS FIND FRAUDSTERS ARE OFTEN INCOMPETENT

    Post 4943

    Read the full article at https://www.linkedin.com/pulse/lose-you-fail-respond-motion-summary-disposition-zalma-esq-cfe-rhstc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.

    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) the Court of Appeals resolved the dispute.

    In a consolidated first-party and third-party no-fault action, plaintiff appealed from two orders granting summary disposition in favor of defendants, including the fraud of the plaintiff.

    FACTUAL BACKGROUND

    After a motor vehicle accident involving plaintiff and Pugh. Plaintiff alleged 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 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.

    Shortly after Pugh filed her motion, Citizens filed its own motion arguing that plaintiff made material misrepresentations to Citizens regarding the extent of his injuries, which rendered him ineligible for benefits under the statute.

    The trial court concluded that plaintiff failed to establish that he sustained a serious impairment of body function and therefore summary disposition in favor of Pugh was appropriate.

    With regard to Citizens’ motion, the trial court found “that absolutely no genuine issue of material fact exists as to whether Plaintiff knowingly made numerous materially false statements in his claims for PIP benefits relative to his alleged injuries and physical restrictions” arising out of the car accident.

    THRESHOLD INJURY

    Plaintiff argued that the trial court erred by finding that there was no genuine issue of material fact regarding whether plaintiff met the serious-impairment threshold. However, plaintiff’s failure to respond to the motion for summary disposition made it impossible for him to support his argument.

    The Plaintiff tried to use the defendants evidence as support against the motions. The attempt failed. The objectively manifested requirement means that plaintiffs must introduce evidence that generally requires medical testimony. Pugh presented objective medical records indicating that there was no physical basis for plaintiff’s subjective complaints of pain. Plaintiff’s deposition testimony only set forth mere subjective complaints of pain.

    Because plaintiff cannot show a factual dispute as to whether he suffered an objectively manifested impairment, he failed to satisfy the threshold serious-impairment requirement.

    FRAUDULENT INSURANCE ACT

    A person who presents or causes to be presented an oral or written statement, including computer-generated information, as part of or in support of a claim for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act that is subject to the penalties imposed by statute.

    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 to the insurer or the state, 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.

    As to both motions for summary disposition, plaintiff failed to show that any genuine issue of material facts exists. Accordingly, the trial court did not err by granting summary disposition in favor of defendants.

    ZALMA OPINION

    As I get older the competence of those who attempt to defraud insurers gets less and less competent. Kallco is an example of the lack of competence. He claimed all kinds of injuries and inability to work or play with his children and, when faced with a competent defense, he ignored the motions, failed to respond, and when he lost he appealed claiming the motions against him gave enough evidence to raise a issue of fact. What a waste of the court’s time and I must ask why, with such convincing evidence, no criminal charges were brought.

    (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

    Sorry about the delay in posting. I’m recovering from pneumonia and spending most of the last week in bed with pills, Kleenex, coughing and sleep which I couldn’t get in the hospital. Should be act in shape next week but doctors make no promises.
    Lose if You Fail to Respond to Motion for Summary Disposition INSURERS FIND FRAUDSTERS ARE OFTEN INCOMPETENT Post 4943 Read the full article at https://www.linkedin.com/pulse/lose-you-fail-respond-motion-summary-disposition-zalma-esq-cfe-rhstc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. 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) the Court of Appeals resolved the dispute. In a consolidated first-party and third-party no-fault action, plaintiff appealed from two orders granting summary disposition in favor of defendants, including the fraud of the plaintiff. FACTUAL BACKGROUND After a motor vehicle accident involving plaintiff and Pugh. Plaintiff alleged 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 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. Shortly after Pugh filed her motion, Citizens filed its own motion arguing that plaintiff made material misrepresentations to Citizens regarding the extent of his injuries, which rendered him ineligible for benefits under the statute. The trial court concluded that plaintiff failed to establish that he sustained a serious impairment of body function and therefore summary disposition in favor of Pugh was appropriate. With regard to Citizens’ motion, the trial court found “that absolutely no genuine issue of material fact exists as to whether Plaintiff knowingly made numerous materially false statements in his claims for PIP benefits relative to his alleged injuries and physical restrictions” arising out of the car accident. THRESHOLD INJURY Plaintiff argued that the trial court erred by finding that there was no genuine issue of material fact regarding whether plaintiff met the serious-impairment threshold. However, plaintiff’s failure to respond to the motion for summary disposition made it impossible for him to support his argument. The Plaintiff tried to use the defendants evidence as support against the motions. The attempt failed. The objectively manifested requirement means that plaintiffs must introduce evidence that generally requires medical testimony. Pugh presented objective medical records indicating that there was no physical basis for plaintiff’s subjective complaints of pain. Plaintiff’s deposition testimony only set forth mere subjective complaints of pain. Because plaintiff cannot show a factual dispute as to whether he suffered an objectively manifested impairment, he failed to satisfy the threshold serious-impairment requirement. FRAUDULENT INSURANCE ACT A person who presents or causes to be presented an oral or written statement, including computer-generated information, as part of or in support of a claim for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act that is subject to the penalties imposed by statute. 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 to the insurer or the state, 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. As to both motions for summary disposition, plaintiff failed to show that any genuine issue of material facts exists. Accordingly, the trial court did not err by granting summary disposition in favor of defendants. ZALMA OPINION As I get older the competence of those who attempt to defraud insurers gets less and less competent. Kallco is an example of the lack of competence. He claimed all kinds of injuries and inability to work or play with his children and, when faced with a competent defense, he ignored the motions, failed to respond, and when he lost he appealed claiming the motions against him gave enough evidence to raise a issue of fact. What a waste of the court’s time and I must ask why, with such convincing evidence, no criminal charges were brought. (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 Sorry about the delay in posting. I’m recovering from pneumonia and spending most of the last week in bed with pills, Kleenex, coughing and sleep which I couldn’t get in the hospital. Should be act in shape next week but doctors make no promises.
    WWW.LINKEDIN.COM
    Discover thousands of collaborative articles on 2500+ skills
    Discover 100 collaborative articles on domains such as Marketing, Public Administration, and Healthcare. Our expertly curated collection combines AI-generated content with insights and advice from industry experts, providing you with unique perspectives and up-to-date information on many skills and their applications.
    0 Comments 0 Shares 766 Views
  • **BREAKING NEWS MICHIGAN:**
    **@MichiganDems reveal new toll road bill for #LameDuck session next week. Call them 517-373-0857 don’t let them toll us!**
    **BREAKING NEWS MICHIGAN:** **@MichiganDems reveal new toll road bill for #LameDuck session next week. Call them 517-373-0857 don’t let them toll us!**
    0 Comments 0 Shares 237 Views

  • Zalma's Insurance Fraud Letter - December 1, 2024

    ZIFL Volume 28 No. 22

    Post 4939

    Read the full article at Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdfand at https://zalma.com/blog.

    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 https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf

    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:

    The EUO is a Material Condition Precedent
    A Key Tool in the Effort to Reduce Fraud
    Claim Properly Denied for Refusal to Testify at EUO

    I spoke recently at the Conference of the Southern California Fraud Investigators Association on the Examination Under Oath as a tool to help insureds prove their losses and what happens when an insured fails or refuses to testify. This case emphasizes the purpose of my talk.

    Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf

    Thanksgiving Wishes from the Zalma Family

    My family and I have much to be thankful for this year. My first born daughter, Stephanie Zalma, continues to care for my wife 24 hours a day 7 days a week with love and patience as Thea continues as Nana to our two grandchildren and the loving mother of our three children.

    After receiving a new Aortic Heart Valve I am personally in good health, walking about 25 miles a week. Exercising my, apparently unusual mode of retirement, I work only six to eight hours a day doing what I love the most, writing about insurance, insurance claims, insurance law and acting as an insurance claims consultant and expert witness.

    Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf

    More McClenny Moseley & Associates Issues

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

    Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf

    Ethical Behavior & Insurance

    Insurance, from the time of its first agreement to the present day has always been a business requiring ethical behavior between the insurer and the insured and between the insured and the insurer.

    The concept of ethical behavior refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues, all of which are essential to the lawyer.

    Ethics refers to those standards that impose the reasonable obligations to refrain from murder, rape, theft, assault, slander, and fraud. Ethical standards also include those that imply virtues of honesty, compassion, and loyalty.

    There are rights presumed to exist such as those described in the Declaration of Independence submitted to King George of England in 1776 that held:

    We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness.

    The unalienable rights also include the right to life, the right to freedom from injury, and the right to liberty. Such standards are adequate standards of ethics because they are supported by consistent and well-founded reasons.

    Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf

    Health Insurance Fraud Convictions

    Michigan Woman Convicted of $1.4M Health Care Kickback Scheme

    Mary Smettler-Bolton, 71, of Oakland County, Michigan was convicted November 22, 2024 for her role in a conspiracy to defraud the United States and receive illegal health care kickbacks.

    According to court documents and evidence presented at trial, Mary referred Medicare beneficiaries to several Metro Detroit home health companies in exchange for hundreds of thousands of dollars in kickbacks paid by the owners and operators of the home health companies. Over the course of four years, she and her co-conspirators caused over $1.4 million of loss to Medicare.

    Smettler-Bolton was convicted of one count of conspiracy to defraud the United States and receive illegal health care kickbacks and one count of violating the federal Anti-Kickback Statute. She is scheduled to be sentenced on March 3, 2025, and faces a maximum penalty of five years in prison on the conspiracy count and a maximum penalty of 10 years in prison on the kickback count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

    Read the full article about dozens more convictions at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf

    Convictions of Other Than Health Insurance Fraud

    Creative Fraudster Guilty of $229K Insurance Fraud Schemes

    Justin Mack, a native of Buffalo, New York, and a resident of Cleveland, Ohio, was sentenced on November 25, 2024 in the Cuyahoga County Court of Common Pleas. Mack, an Ohio man was sentenced to five years in prison and ordered to pay restitution for filing 24 fraudulent claims with multiple insurance companies, totaling more than $229,000.

    An extensive investigation uncovered Mack’s pattern of submitting altered documentation, falsified claims, and using other people’s identities to fraudulently secure payouts from multiple insurance companies.

    Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf

    The Examination Under Oath Is Not Part of a Judicial Process

    Although the EUO is a formal proceeding it is not part of a judicial process nor is it subject to the rules set out by codes of civil procedure. There is no right to object to questions and never a judge present to rule on the objections. The testimony at the EUO is required to be presented in accordance with the obligation imposed on an insured to deal fairly and in good faith with the insurer.

    Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf

    Barry Zalma

    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. Write to Mr. Zalma at [email protected]; https://www.zalma.com; https://zalma.com/blog. He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.

    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
    Zalma's Insurance Fraud Letter - December 1, 2024 ZIFL Volume 28 No. 22 Post 4939 Read the full article at Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdfand at https://zalma.com/blog. 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 https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf 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: The EUO is a Material Condition Precedent A Key Tool in the Effort to Reduce Fraud Claim Properly Denied for Refusal to Testify at EUO I spoke recently at the Conference of the Southern California Fraud Investigators Association on the Examination Under Oath as a tool to help insureds prove their losses and what happens when an insured fails or refuses to testify. This case emphasizes the purpose of my talk. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Thanksgiving Wishes from the Zalma Family My family and I have much to be thankful for this year. My first born daughter, Stephanie Zalma, continues to care for my wife 24 hours a day 7 days a week with love and patience as Thea continues as Nana to our two grandchildren and the loving mother of our three children. After receiving a new Aortic Heart Valve I am personally in good health, walking about 25 miles a week. Exercising my, apparently unusual mode of retirement, I work only six to eight hours a day doing what I love the most, writing about insurance, insurance claims, insurance law and acting as an insurance claims consultant and expert witness. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf More McClenny Moseley & Associates Issues This is ZIFL’s thirty eighth 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 to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Ethical Behavior & Insurance Insurance, from the time of its first agreement to the present day has always been a business requiring ethical behavior between the insurer and the insured and between the insured and the insurer. The concept of ethical behavior refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues, all of which are essential to the lawyer. Ethics refers to those standards that impose the reasonable obligations to refrain from murder, rape, theft, assault, slander, and fraud. Ethical standards also include those that imply virtues of honesty, compassion, and loyalty. There are rights presumed to exist such as those described in the Declaration of Independence submitted to King George of England in 1776 that held: We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness. The unalienable rights also include the right to life, the right to freedom from injury, and the right to liberty. Such standards are adequate standards of ethics because they are supported by consistent and well-founded reasons. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Health Insurance Fraud Convictions Michigan Woman Convicted of $1.4M Health Care Kickback Scheme Mary Smettler-Bolton, 71, of Oakland County, Michigan was convicted November 22, 2024 for her role in a conspiracy to defraud the United States and receive illegal health care kickbacks. According to court documents and evidence presented at trial, Mary referred Medicare beneficiaries to several Metro Detroit home health companies in exchange for hundreds of thousands of dollars in kickbacks paid by the owners and operators of the home health companies. Over the course of four years, she and her co-conspirators caused over $1.4 million of loss to Medicare. Smettler-Bolton was convicted of one count of conspiracy to defraud the United States and receive illegal health care kickbacks and one count of violating the federal Anti-Kickback Statute. She is scheduled to be sentenced on March 3, 2025, and faces a maximum penalty of five years in prison on the conspiracy count and a maximum penalty of 10 years in prison on the kickback count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors. Read the full article about dozens more convictions at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Convictions of Other Than Health Insurance Fraud Creative Fraudster Guilty of $229K Insurance Fraud Schemes Justin Mack, a native of Buffalo, New York, and a resident of Cleveland, Ohio, was sentenced on November 25, 2024 in the Cuyahoga County Court of Common Pleas. Mack, an Ohio man was sentenced to five years in prison and ordered to pay restitution for filing 24 fraudulent claims with multiple insurance companies, totaling more than $229,000. An extensive investigation uncovered Mack’s pattern of submitting altered documentation, falsified claims, and using other people’s identities to fraudulently secure payouts from multiple insurance companies. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf The Examination Under Oath Is Not Part of a Judicial Process Although the EUO is a formal proceeding it is not part of a judicial process nor is it subject to the rules set out by codes of civil procedure. There is no right to object to questions and never a judge present to rule on the objections. The testimony at the EUO is required to be presented in accordance with the obligation imposed on an insured to deal fairly and in good faith with the insurer. Read the full article at https://zalma.com/blog/wp-content/uploads/2024/12/ZIFL-12-01-2024.pdf Barry Zalma 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. Write to Mr. Zalma at [email protected]; https://www.zalma.com; https://zalma.com/blog. He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling. 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
    0 Comments 1 Shares 2K Views
  • https://jihadwatch.org/2024/11/michigan-muslim-influencer-says-allah-sent-muslims-to-civilize-west-uncivilized-westerners-still-use-toilet-paper
    https://jihadwatch.org/2024/11/michigan-muslim-influencer-says-allah-sent-muslims-to-civilize-west-uncivilized-westerners-still-use-toilet-paper
    JIHADWATCH.ORG
    Michigan: Muslim influencer says Allah sent Muslims to civilize West, uncivilized Westerners still use toilet paper
    "Narrated Abu Huraira: The Prophet (???) said, 'Whoever performs ablution should clean his nose with water by putting the water in it and then blowing it out, and whoever cleans his private parts with stones should do it with odd number of stones.'" (Bukhari 1.4.161) "Islamist Influencer In Dearborn, Michigan Lecture For Muslim Teens: Christianity...
    0 Comments 0 Shares 249 Views
  • Deranged White Liberal Women Hold ‘Primal Scream’ Event at Lake Michigan Following Trump Win https://www.infowars.com/posts/deranged-white-liberal-women-hold-primal-scream-event-at-lake-michigan-following-trump-defeat
    Deranged White Liberal Women Hold ‘Primal Scream’ Event at Lake Michigan Following Trump Win https://www.infowars.com/posts/deranged-white-liberal-women-hold-primal-scream-event-at-lake-michigan-following-trump-defeat
    Haha
    2
    0 Comments 0 Shares 268 Views
  • https://thewashingtonstandard.com/michigan-bill-hb6147-advances-steps-against-cbdcs/
    https://thewashingtonstandard.com/michigan-bill-hb6147-advances-steps-against-cbdcs/
    THEWASHINGTONSTANDARD.COM
    Michigan Bill HB6147 Advances Steps Against CBDCs - The Washington Standard
    We’ve been warned that if Central Bank Digital Currencies (CBDC) ever take hold, it will enslave everyone. Indeed! That’s why it is encouraging to see the introduction of a bill in Michigan (HB6147) that would oppose CBDCs. Michigan is just the latest in a line of states that have already ...
    0 Comments 0 Shares 335 Views
  • If you had the chance to tell the Trump White House what changes to make first, what would you say?
    It turns out you do have that chance!
    Last night I was contacted by Dan Scavino, White House Deputy Chief of staff and asked that very question. In full transparency, I believe it was more of a small mass text mailing but I do believe they are sincere in hearing what I (we) think.
    I was told that: “ Listen, every time you made your voice heard, you pushed us one step closer to making history.” And the message said “President Trump hears you; he’s all about delivering on real promises.”
    My response was as follows:

    “1. We need to see the J-6 political prisoners released and have their records cleansed!
    2. We need to see the evil doers held accountable for their deeds. This would include but not be limited to the persons that stole the election, the persons that allowed the steal to take place.
    3. This would also include all persons that enabled the Covid 19 scam, the lying about the efficacy and safety of the covid vax.
    4. This would also include all those that committed lawfare.
    5. We need to immediately clear all 16 Michigan electors such as my friends Meshawn Maddock and Marian Sheridan of any charges, etc.
    6. We need to seek out, expose and prosecute all persons that have contributed to on going election fraud such as we seen where the Dems continue to count fake ballots for up to two weeks after election day.
    7. We severely need help adjudicate the enormous fraud committed here in Michigan by Governor Gretchen Whitmer, SOS Jocelyn Benson and AG Dana Nessel.
    The Michigan Executive Branch is Corrupt! ______________________

    Michigan Governor, Gretchen Whitmer, corruption evidence:
    (drive.google.com/file/d/19MflA1…)
    (drive.google.com/file/d/1T29ZLK…)
    (drive.google.com/file/d/16WM5R-…)

    Michigan Secretary Of State, Jocelyn Benson, corruption evidence:
    (drive.google.com/file/d/1hf4hkN…)
    (drive.google.com/file/d/1PGHeLK…)
    (drive.google.com/file/d/1VvdHRF…)

    Michigan Attorney General, Dana Nessel corruption evidence:
    (drive.google.com/file/d/1-MNG_5…)
    (drive.google.com/file/d/1LX5pOg…)
    Clearly Justice must begin and continue until completion!”

    So, now I ask you; What would you like to see Trump accomplish first?
    Let’s make sure that the Trump Whitehouse continues to listen to us!
    Bob Cushman
    11-23-24
    @pjcolbeck @PattyLovesTruth @gatewaypundit @HawleyMO @Jim_Jordan @JudiciaryGOP @SpeakerJohnson @CLewandowski_ @elonmusk @MIGOP @JudicialWatch @America1stLegal @LaraLeaTrump @StephenM @realDonaldTrump @EricTrump @DonaldJTrumpJr @JDVance @RobertKennedyJr @NicoleShanahan @TrueTheVote @LauraLoomer @MeshawnMaddock @matthewmaddock @KristinaKaramo @danscavino_000

    https://x.com/BobCushman1776/status/1860343334830588396?t=v7lHPA8X2l5CFJ_tNcFSUA&s=19
    If you had the chance to tell the Trump White House what changes to make first, what would you say? It turns out you do have that chance! Last night I was contacted by Dan Scavino, White House Deputy Chief of staff and asked that very question. In full transparency, I believe it was more of a small mass text mailing but I do believe they are sincere in hearing what I (we) think. I was told that: “ Listen, every time you made your voice heard, you pushed us one step closer to making history.” And the message said “President Trump hears you; he’s all about delivering on real promises.” My response was as follows: “1. We need to see the J-6 political prisoners released and have their records cleansed! 2. We need to see the evil doers held accountable for their deeds. This would include but not be limited to the persons that stole the election, the persons that allowed the steal to take place. 3. This would also include all persons that enabled the Covid 19 scam, the lying about the efficacy and safety of the covid vax. 4. This would also include all those that committed lawfare. 5. We need to immediately clear all 16 Michigan electors such as my friends Meshawn Maddock and Marian Sheridan of any charges, etc. 6. We need to seek out, expose and prosecute all persons that have contributed to on going election fraud such as we seen where the Dems continue to count fake ballots for up to two weeks after election day. 7. We severely need help adjudicate the enormous fraud committed here in Michigan by Governor Gretchen Whitmer, SOS Jocelyn Benson and AG Dana Nessel. The Michigan Executive Branch is Corrupt! ______________________ Michigan Governor, Gretchen Whitmer, corruption evidence: (drive.google.com/file/d/19MflA1…) (drive.google.com/file/d/1T29ZLK…) (drive.google.com/file/d/16WM5R-…) Michigan Secretary Of State, Jocelyn Benson, corruption evidence: (drive.google.com/file/d/1hf4hkN…) (drive.google.com/file/d/1PGHeLK…) (drive.google.com/file/d/1VvdHRF…) Michigan Attorney General, Dana Nessel corruption evidence: (drive.google.com/file/d/1-MNG_5…) (drive.google.com/file/d/1LX5pOg…) Clearly Justice must begin and continue until completion!” So, now I ask you; What would you like to see Trump accomplish first? Let’s make sure that the Trump Whitehouse continues to listen to us! Bob Cushman 11-23-24 @pjcolbeck @PattyLovesTruth @gatewaypundit @HawleyMO @Jim_Jordan @JudiciaryGOP @SpeakerJohnson @CLewandowski_ @elonmusk @MIGOP @JudicialWatch @America1stLegal @LaraLeaTrump @StephenM @realDonaldTrump @EricTrump @DonaldJTrumpJr @JDVance @RobertKennedyJr @NicoleShanahan @TrueTheVote @LauraLoomer @MeshawnMaddock @matthewmaddock @KristinaKaramo @danscavino_000 https://x.com/BobCushman1776/status/1860343334830588396?t=v7lHPA8X2l5CFJ_tNcFSUA&s=19
    0 Comments 0 Shares 2K Views
  • IS FEMA REALLY IN MICHIGAN?

    A "wall" would be used to KEEP YOU IN!


    https://old.bitchute.com/video/1KHo4DozFinL/
    IS FEMA REALLY IN MICHIGAN? A "wall" would be used to KEEP YOU IN! https://old.bitchute.com/video/1KHo4DozFinL/
    OLD.BITCHUTE.COM
    IS FEMA REALLY IN MICHIGAN?
    GET YOUR MONEY OUT OF THE BANK AND GET GOLD AND SILVER IN YOUR HANDS CLOCK IS TICKING. REAL GOLD NOT FIAT PAPER OR 1S AND 0S www.Richielikesgold.com https://kfor.com/news/local/multiple-people-report-odd-symptoms-following-mosquito-bites-in-oklahom…
    0 Comments 0 Shares 290 Views

  • Zalma’s Insurance Fraud Letter September 15, 2024

    Zalma’s Insurance Fraud Letter

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

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

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

    Thomas Jefferson

    Insurance Fraud Requires Doctor to Lose his License

    Sexual Misconduct, Fraud, Bribery & Unnecessary Surgery Revokes License

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

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

    FACTS

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

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

    THE OAL HEARING

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

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

    THE ALJ’S DECISION

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

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

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

    Quartararo Argued

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

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

    ZIFL OPINION

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

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

    IT PAYS INSURER DEFENDANTS TO INVESTIGATE INJURY CLAIMS

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

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

    FACTUAL BACKGROUND

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

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

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

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

    THRESHOLD INJURY

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

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

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

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

    FRAUDULENT INSURANCE ACT

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

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

    ZIFL OPINION

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

    More McClenny Moseley & Associates Issues

    This is ZIFL’s thirty seventh installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.

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

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

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

    Indicators of Bad Faith Set Up

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

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

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

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

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

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

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

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

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

    Barry Zalma, Esq., CFE

    Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
    Zalma’s Insurance Fraud Letter September 15, 2024 Zalma’s Insurance Fraud Letter A ClaimSchool™ Publication © 2024 Barry Zalma & ClaimSchool, Inc. Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkycVolume 28, Issue 21 – November 15, 2024 “Honor, justice, and humanity, forbid us tamely to surrender that freedom which we received from our gallant ancestors, and which our innocent posterity have a right to receive from us. We cannot endure the infamy and guilt of resigning succeeding generations to that wretchedness which inevitably awaits them if we basely entail hereditary bondage on them.” Thomas Jefferson Insurance Fraud Requires Doctor to Lose his License Sexual Misconduct, Fraud, Bribery & Unnecessary Surgery Revokes License Louis Quartararo appealed from an August 22, 2022 final agency decision of the State Board of Medical Examiners (Board), revoking his license to practice medicine and surgery in New Jersey. The Superior Court of New Jersey, in In The Matter Of The Suspension Or Revocation Of The License Of Louis Quartararo, M.D. License No. 25MA07137700 To Practice Medicine And Surgery In The State Of New Jersey, No. A-0425-22, Superior Court of New Jersey, Appellate Division (October 31, 2024) affirmed the revocation. The Board charged Dr. Quartararo with engaging in sexual contact with patients; negligent acts by performing surgeries with co-surgeons who lacked the requisite privileges; and acts of fraud, deception and misrepresentation by miscoding procedures on patient operative reports and listing procedures in the reports he had not performed for the purpose of ensuring insurance coverage. FACTS Quartararo was a physician and Board-certified orthopedic surgeon licensed to practice medicine in New Jersey. Approximately one week before K.D. was scheduled to meet with Board investigators, Quartararo gave K.D. $20,916, which K.D. told an investigator was “for school.” Later, Quartararo’s attorney offered her more money to retract the statement she had made to the Board about her relationship with Quartararo. THE OAL HEARING At a formal hearing, the Board’s expert, Dr. Ashraf addressed Quartararo’s treatment of patient Y.O. revealed that the surgical procedures Quartararo performed were not medically necessary. In reviewing the description of Quartararo’s procedure on Y.O.’s spine, Dr. Ashraf concluded that Quartararo’s surgery on Y.O.’s completely normal spine “is gross negligence.” Regarding the fraud claims alleging that Quartararo had failed to properly code surgical procedures that he performed on E.S., D.C., Y.O., L.V., D.E., and V.C., Dr. Ashraf testified that the “whole function” of the “operations” section on the first page of the operative report was to list the procedures that were performed during the operation and he testified that, despite “laminotomy” appearing on the first page of V.C.’s and D.C.’s reports, their post-surgery MRIs revealed that laminotomies had not been performed. THE ALJ’S DECISION The Administrative Law Judge (ALJ) issued a comprehensive seventy-nine-page decision and concluded that Quartararo had “engaged in gross malpractice, professional misconduct, failure to comply with regulations administered by the Board, and failure to be of good moral character.” On August 22, 2022, the Board filed its final decision, revoking Quartararo’s license for a minimum of seven years from the date of voluntary surrender, April 5, 2019. The Board concluded that Quartararo’s “misconduct warrants a serious penalty in excess of that recommended by [the ALJ]” and that he “flagrantly ignored, and in fact shattered professional norms when he engaged in sexual misconduct with patients Y.R. and K.D.” The Board found Quartararo’s conduct was “so egregious that the only appropriate discipline is a license revocation.” The Board also imposed an aggregate monetary sanction of $343,909.75, comprised of a civil penalty of $90,000, $61,684.75 in costs, and $192,225 in attorney’s fees. Quartararo Argued The Board determined that revocation was warranted because he preyed on two vulnerable patients employed intimidation and coercion tactics to dissuade at least one of his victims-K.D.- from testifying about the true nature of their relation and resorted to making threats resulting in the issuance of a temporary restraining order against him. Quartararo admitted he had not performed laminotomies and that he had used the laminotomy code to ensure that he would be paid by insurance carriers. He did so rather than correctly coding the procedures he actually performed because of the risk he would otherwise not be paid. ZIFL OPINION Quartararo admitted before the ALJ that he committed fraud by billing insurers for laminotomies that he did not perform. As such he admitted to committing a federal as well as a New Jersey felony that should be presented to the US Attorney and the local District Attorney for prosecution. He lost his license because he took advantage sexually of vulnerable patients, committed gross acts of malpractice and profited from knowing insurance fraud. The people of New Jersey are now safe from his criminal and unprofessional conduct for a few more years, and in my opinion he should be prosecuted and sentenced to prison for the fraud. Read the full issue at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-november-15-2024-barry-zalma-esq-cfe-cxkyc IT PAYS INSURER DEFENDANTS TO INVESTIGATE INJURY CLAIMS In Chris Kallco v. Melissa Lynn Pugh, Chris Kallco, and Precise Mri Of Michigan, LLC v. Citizens Insurance Company Of The Midwest and Melissa Lynn Pugh, No. 368156, Court of Appeals of Michigan (October 30, 2024) affirmed the trial court’s decision. Plaintiff appealed from two orders granting summary disposition in favor of defendants even though he failed to respond to either motion. FACTUAL BACKGROUND This case arises out of a motor vehicle accident that occurred on March 9, 2020 involving plaintiff and Pugh. Plaintiff alleges that he sustained injuries from the accident. A year after the accident, plaintiff brought a negligence claim against Pugh, alleging that, because of Pugh’s negligence, plaintiff sustained “severe permanent and progressive personal injuries and serious impairment of a body function, including but not necessarily limited to: Head, Neck, Back, Shoulders ….” Plaintiff also brought a claim against Citizens for PIP benefits, including medical expenses, work loss, and replacement services. Pugh and Citizens moved for summary disposition arguing that plaintiff could not meet his burden of showing that he sustained a threshold injury under the no-fault act and, therefore, he could not maintain his negligence claim against her. Pugh submitted the deposition testimony of the plaintiff and the report of an independent medical examination (IME) conducted by Dr. James Bragman on December 27, 2021. Dr. Bragman further observed that plaintiff had “near full range of motion” in his neck and that he was “eminently capable” of standing and touching his toes despite his refusal to do so. Dr. Bragman noted that plaintiff had “very little” medical treatment documented in his records and that he had been undergoing physical therapy for six months with no medical basis for doing so. An investigator’s report includes pictures of plaintiff walking, riding a child’s bicycle, squatting, bending over, lifting a bicycle out of a minivan unassisted, playing with a dog, driving a car, and twisting his neck. Citizens’ motion argued that plaintiff made material misrepresentations to Citizens regarding the extent of his injuries, which rendered him ineligible for benefits. The trial court found that, based upon the evidence presented, plaintiff failed to establish that he sustained a serious impairment of body function and therefore summary disposition in favor of Pugh was appropriate. THRESHOLD INJURY Plaintiff argued that the trial court erred by granting summary disposition in favor of Pugh. Under the no fault statute, the threshold question of whether the person has suffered a serious impairment of body function should be determined by the court as a matter of law as long as there is no factual dispute regarding the nature and extent of the person’s injuries that is material to determining whether the threshold standards are met. Plaintiff was obligated to respond to Pugh’s motion in order to meet his burden of demonstrating that a fact question existed as to whether he suffered a serious impairment of body function. The parts of plaintiff’s deposition identified by Pugh do not establish a genuine issue of material fact as to whether he suffered a serious impairment of body function. The relevant portions of plaintiff’s deposition testimony fail to rebut the evidence and instead set forth, at best, mere subjective complaints of pain. FRAUDULENT INSURANCE ACT The fraud statute finds that a person who presents or causes or to be presented an oral or written statement knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act under that is subject to the penalties imposed under the statute. A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment of PIP benefits. An individual commits a “fraudulent insurance act” when: (1) the person presents or causes to be presented an oral or written statement, (2) the statement is part of or in support of a claim for no-fault benefits, and (3) the claim for benefits was submitted to the MAIPF. Further, (4) the person must have known that the statement contained false information, and (5) the statement concerned a fact or thing material to the claim. ZIFL OPINION The evidence presented by the defendants were damning since they established the injuries claimed were false. Plaintiff failed to respond to the motions to his detriment and sought reconsideration without any admissible evidence that he was truly injured. The defendants established that the Plaintiff committed fraud and he is lucky that this was a civil finding not a criminal proceeding that, in my opinion, should be presented by the prosecutor. More McClenny Moseley & Associates Issues This is ZIFL’s thirty seventh installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana. Health Insurance Fraud Convictions Pharmacist and Brother Convicted of $15M Medicare, Medicaid, and Private Insurer Fraud Scheme Raad Kouza, a pharmacist in Wayne County, Michigan, and his brother, Ramis Kouza, of Oakland County, Michigan, billed Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for prescription medications that they did not dispense at pharmacies they owned or operated in Michigan. A federal jury convicted the pharmacy owner and his brother November 8, 2024 for conspiracy to commit health care fraud and wire fraud. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Indicators of Bad Faith Set Up Some of the more common red flags of a bad faith set-up include the following: The claimant makes a policy limits settlement demand quickly after an accident, thereby depriving the insurer of the ability to conduct a full investigation. Quick demands that are combined with a limited amount of time to accept, again, in the hopes that records cannot be obtained and the investigation cannot be completed within that limited time period, and the settlement will be refused. The claimant makes a settlement offer with one or more unusual acceptance conditions. The involvement of the claimant’s counsel pre-dates certain medical or psychiatric care (e.g., testing and treatment for alleged mild traumatic brain injury) Read the full article and the full issue of ZIFL at http://https//zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024.pdf Convictions of Other Than Health Insurance Fraud Star in Reality TV Series Pleads Guilty Crop Insurance Fraud Steve A. McBee, 52, waived his right to a grand jury and pleaded guilty to a federal information that charges him with one count of federal crop insurance fraud. McBee, a Missouri farmer who appears in a reality TV show about his family’s farming operation pleaded guilty this week to a multi-million dollar fraud scheme involving federal crop insurance benefits. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Chutzpah – STOLI Fraudster Claims Hardship Felon Seeks Release from Home Confinement in Luxury Apartment in New York City Insurance Fraud is a serious crime, especially when it takes advantage of the elderly to defraud insurers in a Stranger Originated Life Insurance (STOLI) scheme. In United States Of America v. Michael Binday, No. 12 CR 152 (CM), United States District Court, S.D. New York (November 4, 2024) the defendant continued to use the wealth he gained from his fraud to impose on the courts of the United States with frivolous and unfounded motions. Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2024/11/ZIFL-11-15-2024-1.pdf Barry Zalma, Esq., CFE Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
    WWW.LINKEDIN.COM
    Discover thousands of collaborative articles on 2500+ skills
    Discover 100 collaborative articles on domains such as Marketing, Public Administration, and Healthcare. Our expertly curated collection combines AI-generated content with insights and advice from industry experts, providing you with unique perspectives and up-to-date information on many skills and their applications.
    0 Comments 0 Shares 4K Views
More Results
Sponsored

We are 100% funded for October.

Thanks to everyone who helped out. 🥰

Xephula monthly operating expenses for 2024 - Server: $143/month - Backup Software: $6/month - Object Storage: $6/month - SMTP Service: $10/month - Stripe Processing Fees: ~$10/month - Total: $175/month

Xephula Funding Meter

Please Donate Here