• "JUSTICE" IS NOT "REVENGE"!!! IMHO: ALL OF THE PEOPLE "RESPONSIBLE", FOR GIVING ORDERS, AND "FOLLOWING ORDERS, ALL THE WAY DOWN TO ADMINISTERING THE "KILL SHOTS", ARE GUILTY OF PARTICIPATING IN THE CONSPIRACY TO COMMIT MASS-MURDER, WORLDWIDE, FOR FUN AND PROFIT!!! THEY ALL MUST NOW BE ARRESTED, AND HANGED, FOR THEIR TRAITOROUS CRIMES AGAINST HUMANIITY!! ASAP.
    NO DELAYS, NO EXCUSES, NO EXCEPTIONS, NO "AMNESTY", NO MERCY!!!


    https://cdn2.efficientvideo.com/44626a67-cfe1-4d64-a83b-84bb60da784f/d79aaa1e-8ff0-45a9-9ae8-eb0d16c1d4a7/original?
    "JUSTICE" IS NOT "REVENGE"!!! IMHO: ALL OF THE PEOPLE "RESPONSIBLE", FOR GIVING ORDERS, AND "FOLLOWING ORDERS, ALL THE WAY DOWN TO ADMINISTERING THE "KILL SHOTS", ARE GUILTY OF PARTICIPATING IN THE CONSPIRACY TO COMMIT MASS-MURDER, WORLDWIDE, FOR FUN AND PROFIT!!! THEY ALL MUST NOW BE ARRESTED, AND HANGED, FOR THEIR TRAITOROUS CRIMES AGAINST HUMANIITY!! ASAP. NO DELAYS, NO EXCUSES, NO EXCEPTIONS, NO "AMNESTY", NO MERCY!!! 💩💥 https://cdn2.efficientvideo.com/44626a67-cfe1-4d64-a83b-84bb60da784f/d79aaa1e-8ff0-45a9-9ae8-eb0d16c1d4a7/original?
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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.
    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.
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    0 Kommentare 0 Anteile 166 Ansichten
  • RFK EXPOSING BILL GATES TO KEEP HIM AWAY FROM THE TRUMP ADMINISTRATION

    I don't trust NONE of you!
    But Bill Gates should be EXECUTED live on television for the world to see for his #CrimeAgainstHumanity!

    The scumbag has destroyed the lives of countless young women in India....
    And that was BEFORE his scamdemic #Genocide weapon JABS!

    NONE of you MF's are worth 50 cents because
    NO JUSTICE is in the works!
    PERIOD!

    #Police will GLADLY murder any American over a traffic code violation.....
    But they cannot arrest a MF GUILTY OF MURDERING MILLIONS!

    As usual.... ALL TALK, NO ACTION!

    https://old.bitchute.com/video/PvmOZkw42ZmR/
    RFK EXPOSING BILL GATES TO KEEP HIM AWAY FROM THE TRUMP ADMINISTRATION I don't trust NONE of you! But Bill Gates should be EXECUTED live on television for the world to see for his #CrimeAgainstHumanity! The scumbag has destroyed the lives of countless young women in India.... And that was BEFORE his scamdemic #Genocide weapon JABS! NONE of you MF's are worth 50 cents because NO JUSTICE is in the works! PERIOD! #Police will GLADLY murder any American over a traffic code violation..... But they cannot arrest a MF GUILTY OF MURDERING MILLIONS! As usual.... ALL TALK, NO ACTION! https://old.bitchute.com/video/PvmOZkw42ZmR/
    0 Kommentare 0 Anteile 146 Ansichten
  • https://justthenews.com/government/courts-law/teenager-accused-swatting-hundreds-places-nationwide-pleads-guilty
    https://justthenews.com/government/courts-law/teenager-accused-swatting-hundreds-places-nationwide-pleads-guilty
    JUSTTHENEWS.COM
    Teenager accused of swatting hundreds of places nationwide pleads guilty
    The teenager was mostly underage at the time of the calls, but he faces up to five years for each of the four charges.
    Angry
    1
    0 Kommentare 0 Anteile 64 Ansichten

  • 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
    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
    WWW.LINKEDIN.COM
    Discover thousands of collaborative articles on 2500+ skills
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  • Peter Strzok Has a Necktie Party Waiting for Him, Too.
    §2381. Treason
    More information BELOW THE VIDEO on the channel.
    Whoever, owing allegiance to the United States, levies war against them or adheres to their enemies, giving them aid and comfort within the United States or elsewhere, is guilty of treason and shall suffer death, or shall be imprisoned not less than five years and fined under this title but not less than $10,000; and shall be incapable of holding any office under the United States.
    (June 25, 1948, ch. 645, 62 Stat. 807; Pub. L. 103–322, title XXXIII, §330016(2)(J), Sept. 13, 1994, 108 Stat. 2148.)
    Peter Strzok Has a Necktie Party Waiting for Him, Too. §2381. Treason More information BELOW THE VIDEO on the channel. Whoever, owing allegiance to the United States, levies war against them or adheres to their enemies, giving them aid and comfort within the United States or elsewhere, is guilty of treason and shall suffer death, or shall be imprisoned not less than five years and fined under this title but not less than $10,000; and shall be incapable of holding any office under the United States. (June 25, 1948, ch. 645, 62 Stat. 807; Pub. L. 103–322, title XXXIII, §330016(2)(J), Sept. 13, 1994, 108 Stat. 2148.)
    0 Kommentare 1 Anteile 191 Ansichten

  • Chiropractor Disciplined for Improper Billing

    Chiropractor Lies to Board and Loses Right to Practice

    Post 4930

    Read the full article at https://www.linkedin.com/pulse/chiropractor-disciplined-improper-billing-barry-zalma-esq-cfe-4qjdc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.

    This appeal arises from an attempt by the state of Illinois to impose discipline upon plaintiff Christopher D. Leone, D.C., due to certain improper activities performed as a licensed chiropractor in the state of Illinois.

    In Christopher D. Leone, D.C. v. The Department Of Financial And Professional Regulation, Division Of Professional Regulation; and Cecilia Abundis, in Her Official Capacity as Acting Director of the Department of Financial and Professional Regulation, No. 4-22-0753, 2024 IL App (4th) 220753-U, Court of Appeals of Illinois, Fourth District (November 6, 2024) the Court of Appeal resolved the multiple claims of the chiropractor.

    BACKGROUND

    Leone has practiced as a chiropractor since 1999 and initially practiced in the state of Washington. The matter was resolved pursuant to an informal disposition via stipulation.

    Leone began practicing in Illinois in 2004, and in 2010 and a consent order was issued pursuant to which Leone admitted to the allegations and was reprimanded with a $5000 fine and a requirement that he undertake 20 hours of continuing education; 10 of those hours were to focus on Medicare billing and insurance coding and another 10 on record keeping.

    In 2013, the United States alleged that Leone “knowingly and fraudulently” submitted Medicare claims of less than $1000 for one-on-one physical therapy services that were not provided. Following negotiation, the parties entered into a plea agreement, pursuant to which Leone pleaded guilty to the one-count information and stipulated to a factual basis for his plea.

    Shortly after the Medicare fraud charge was filed against Leone, the State filed a five-count complaint alleging multiple violations of the Medical Practices Act of 1987 (Act). During the litigation, Leone applied to renew his chiropractic license. One of the questions on the application asked whether he had been convicted of any criminal offense, state or federal, since July 2011; Leone answered, “No,” failing to document the Medicare fraud conviction.

    Attempting to explain his federal guilty plea, Leone said that he was unable to modify the language in the plea agreement, as “the time for negotiations had run out” and the plea was a “take-it-or-leave-it” proposition. Leone read the plea agreement line by line and, although he claimed it contained false information, he signed it.

    ALJ Report and Recommendation

    The Administrative Law Judge (ALJ) issued his report and recommendation, finding that, pursuant to the guilty plea in the federal case, Leone had admitted that his patients performed physical therapy on their own without supervision. Also, Leone admitted in his plea that entries in patient records indicating that they received hands-on or one-on-one physical therapy were false. Further, the guilty plea established that Leone knowingly submitted claims to Medicare for services that he did not provide. Leone had also billed private insurers numerous times under the same code as Medicare.

    The conviction also established that he engaged in false billing and false entries in patient records. The ALJ recommended an indefinite suspension of Leone’s license for a minimum of two years.

    An expert testified that chiropractors who engaged in Medicare fraud violated several tenets of chiropractic ethics.

    There was a pattern of overcharging for services that were not provided, false notations in patient records to support the false charges, and the submission of false claims to insurance that went on for at least five years. Leone obtained fees by fraud, deceit, or misrepresentation, and those actions fell below the professional and ethical standards required of chiropractors in Illinois. Leone’s conduct, along with his past disciplinary history, “demonstrate[d] a pattern of behavior that [was] not acceptable.”

    ANALYSIS

    It was undisputed that Leone submitted charges under billing code 97110. Leone pled guilty to submitting a false demand for payment upon the United States. In his plea, Leone admitted to billing for services that were not actually provided to his patients as claimed, “and the instruments containing the demands for payment of public money, therefore were false when they were submitted” and “were submitted to Medicare with the knowledge that he did not perform the service charged.”

    The guilty plea supports the conclusion that Leone knowingly and intentionally submitted claims for reimbursement for services provided under code 97110 where the services did not meet the requirements to be paid under that code. This pattern went on for approximately five years, resulting in 1324 false claims in the amount of $93,900.

    The Department established a violation of the Act where Leone failed to note the federal conviction on his renewal application.
    Discipline

    A review of the initial circuit court order in this matter reveals that it merely recommended that the Department consider probation as a punishment; it did not make a ruling to that effect.

    There was no abuse of discretion in the discipline imposed. For the reasons stated, the Court reversed the circuit court’s judgment and affirm the Director’s decision.

    ZALMA OPINION

    Leone successfully committed fraud on the United States, the state of Illinois, and the insurance industry by falsely billing services he did not provide. He pleaded guilty to one count of Federal Health Insurance fraud and then lied to the state of Illinois when he applied to renew his license. With lawyers and retained experts he delayed the sanction for years. The Court of Appeals finally resolved the multiple disputes and applied an appropriate sanction and suspension of his license. He should consider himself lucky that he was not prosecuted criminally by the state and the US Government accepted his plea.

    (c) 2024 Barry Zalma & ClaimSchool, Inc.

    Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.

    Subscribe to my substack at https://barryzalma.substack.com/subscribe

    Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg

    Go to the Insurance Claims Library – https://lnkd.in/gwEYk
    Chiropractor Disciplined for Improper Billing Chiropractor Lies to Board and Loses Right to Practice Post 4930 Read the full article at https://www.linkedin.com/pulse/chiropractor-disciplined-improper-billing-barry-zalma-esq-cfe-4qjdc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. This appeal arises from an attempt by the state of Illinois to impose discipline upon plaintiff Christopher D. Leone, D.C., due to certain improper activities performed as a licensed chiropractor in the state of Illinois. In Christopher D. Leone, D.C. v. The Department Of Financial And Professional Regulation, Division Of Professional Regulation; and Cecilia Abundis, in Her Official Capacity as Acting Director of the Department of Financial and Professional Regulation, No. 4-22-0753, 2024 IL App (4th) 220753-U, Court of Appeals of Illinois, Fourth District (November 6, 2024) the Court of Appeal resolved the multiple claims of the chiropractor. BACKGROUND Leone has practiced as a chiropractor since 1999 and initially practiced in the state of Washington. The matter was resolved pursuant to an informal disposition via stipulation. Leone began practicing in Illinois in 2004, and in 2010 and a consent order was issued pursuant to which Leone admitted to the allegations and was reprimanded with a $5000 fine and a requirement that he undertake 20 hours of continuing education; 10 of those hours were to focus on Medicare billing and insurance coding and another 10 on record keeping. In 2013, the United States alleged that Leone “knowingly and fraudulently” submitted Medicare claims of less than $1000 for one-on-one physical therapy services that were not provided. Following negotiation, the parties entered into a plea agreement, pursuant to which Leone pleaded guilty to the one-count information and stipulated to a factual basis for his plea. Shortly after the Medicare fraud charge was filed against Leone, the State filed a five-count complaint alleging multiple violations of the Medical Practices Act of 1987 (Act). During the litigation, Leone applied to renew his chiropractic license. One of the questions on the application asked whether he had been convicted of any criminal offense, state or federal, since July 2011; Leone answered, “No,” failing to document the Medicare fraud conviction. Attempting to explain his federal guilty plea, Leone said that he was unable to modify the language in the plea agreement, as “the time for negotiations had run out” and the plea was a “take-it-or-leave-it” proposition. Leone read the plea agreement line by line and, although he claimed it contained false information, he signed it. ALJ Report and Recommendation The Administrative Law Judge (ALJ) issued his report and recommendation, finding that, pursuant to the guilty plea in the federal case, Leone had admitted that his patients performed physical therapy on their own without supervision. Also, Leone admitted in his plea that entries in patient records indicating that they received hands-on or one-on-one physical therapy were false. Further, the guilty plea established that Leone knowingly submitted claims to Medicare for services that he did not provide. Leone had also billed private insurers numerous times under the same code as Medicare. The conviction also established that he engaged in false billing and false entries in patient records. The ALJ recommended an indefinite suspension of Leone’s license for a minimum of two years. An expert testified that chiropractors who engaged in Medicare fraud violated several tenets of chiropractic ethics. There was a pattern of overcharging for services that were not provided, false notations in patient records to support the false charges, and the submission of false claims to insurance that went on for at least five years. Leone obtained fees by fraud, deceit, or misrepresentation, and those actions fell below the professional and ethical standards required of chiropractors in Illinois. Leone’s conduct, along with his past disciplinary history, “demonstrate[d] a pattern of behavior that [was] not acceptable.” ANALYSIS It was undisputed that Leone submitted charges under billing code 97110. Leone pled guilty to submitting a false demand for payment upon the United States. In his plea, Leone admitted to billing for services that were not actually provided to his patients as claimed, “and the instruments containing the demands for payment of public money, therefore were false when they were submitted” and “were submitted to Medicare with the knowledge that he did not perform the service charged.” The guilty plea supports the conclusion that Leone knowingly and intentionally submitted claims for reimbursement for services provided under code 97110 where the services did not meet the requirements to be paid under that code. This pattern went on for approximately five years, resulting in 1324 false claims in the amount of $93,900. The Department established a violation of the Act where Leone failed to note the federal conviction on his renewal application. Discipline A review of the initial circuit court order in this matter reveals that it merely recommended that the Department consider probation as a punishment; it did not make a ruling to that effect. There was no abuse of discretion in the discipline imposed. For the reasons stated, the Court reversed the circuit court’s judgment and affirm the Director’s decision. ZALMA OPINION Leone successfully committed fraud on the United States, the state of Illinois, and the insurance industry by falsely billing services he did not provide. He pleaded guilty to one count of Federal Health Insurance fraud and then lied to the state of Illinois when he applied to renew his license. With lawyers and retained experts he delayed the sanction for years. The Court of Appeals finally resolved the multiple disputes and applied an appropriate sanction and suspension of his license. He should consider himself lucky that he was not prosecuted criminally by the state and the US Government accepted his plea. (c) 2024 Barry Zalma & ClaimSchool, Inc. Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos. Subscribe to my substack at https://barryzalma.substack.com/subscribe Go to X @bzalma; Go to Newsbreak.com https://www.newsbreak.com/@c/1653419?s=01; Go to Barry Zalma videos at Rumble.com at https://rumble.com/account/content?type=all; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg Go to the Insurance Claims Library – https://lnkd.in/gwEYk
    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.
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  • According to retired U.S. Army Major General Paul E. Vallely, if Pentagon officials go through with their attempts to subvert the will of POTUS47, they will be facing TREASON charges.

    TREASON: Military Brass Holding ‘Informal Discussions’ on How to Override Trump 47’s Orders
    https://www.thegatewaypundit.com/2024/11/treason-military-brass-holding-informal-discussions-how-override/
    
    §2381. Treason
    Whoever, owing allegiance to the United States, levies war against them or adheres to their enemies, giving them aid and comfort within the United States or elsewhere, is guilty of treason and shall suffer death, or shall be imprisoned not less than five years and fined under this title but not less than $10,000; and shall be incapable of holding any office under the United States.
    (June 25, 1948, ch. 645, 62 Stat. 807; Pub. L. 103–322, title XXXIII, §330016(2)(J), Sept. 13, 1994, 108 Stat. 2148.)
    According to retired U.S. Army Major General Paul E. Vallely, if Pentagon officials go through with their attempts to subvert the will of POTUS47, they will be facing TREASON charges. TREASON: Military Brass Holding ‘Informal Discussions’ on How to Override Trump 47’s Orders https://www.thegatewaypundit.com/2024/11/treason-military-brass-holding-informal-discussions-how-override/  §2381. Treason Whoever, owing allegiance to the United States, levies war against them or adheres to their enemies, giving them aid and comfort within the United States or elsewhere, is guilty of treason and shall suffer death, or shall be imprisoned not less than five years and fined under this title but not less than $10,000; and shall be incapable of holding any office under the United States. (June 25, 1948, ch. 645, 62 Stat. 807; Pub. L. 103–322, title XXXIII, §330016(2)(J), Sept. 13, 1994, 108 Stat. 2148.)
    0 Kommentare 1 Anteile 246 Ansichten

  • Permanent Punishment for Conviction for One Ounce of Cocaine Improper

    Government Overreach and Abuse Reversed

    Post 4927

    Read the full article at https://www.linkedin.com/pulse/permanent-punishment-conviction-one-ounce-cocaine-zalma-esq-cfe-geq1c, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.

    After Recovery From Cocaine Abuse Dr. Regained License to Practice CMS Refused to Allow Dr. White to Bill Medicare for Services

    Dr. Stephen White challenged two unfavorable decisions made by the Secretary for the United States Department of Health and Human Services (the “Secretary”) that denied and revoked his Medicare enrollment. The decisions, rendered by the Appellate Division of the Departmental Appeals Board (“Board”), were based on Dr. White’s 2010 guilty plea and deferred prosecution for possession of less than 1 gram of cocaine, which occurred in Texas in 2007.

    In Stephen White, M.D. v. Xavier Becerra, Secretary for the United States Department of Health and Human Services, No. 2:19-CV-00037-SAB, United States District Court, E.D. Washington (October 28, 2024) the USDC applied entered a judgment reversing the decision of the Secretary [42 U.S.C. § 405(g).]

    SUMMARY JUDGMENT

    Summary judgment is appropriate if the movant shows that there is no genuine dispute as to any material fact.

    BACKGROUND

    Dr. White is an orthopedic surgeon. In 2006 and 2007, he was arrested and charged with possession of cocaine in Texas. He was able to rehab and become clean of his problem with the drug. The Texas Medical Board revoked his license, but then monitored his recovery and compliance and allowed him to practice again.

    Dr. White had no violations for nine years following his arrest. He is currently practicing medicine in Washington state and is an enrolled Medicare supplier.

    The Administrative Law Judge (ALJ) sustained the denial, finding that CMS had a legitimate basis because Dr. White was convicted of a felony offense. The Board affirmed the ALJ’s decision and Dr. White appealed that decision to the USDC.

    OVERVIEW OF MEDICARE PROGRAM

    The Medicare program provides health insurance benefits to people sixty-five years old or older and to eligible disabled persons. Suppliers, such as Dr. White, must be enrolled in the Medicare program and be granted billing privileges to be eligible to receive payment for care and services rendered to a Medicare-eligible beneficiary.

    DENIALS

    CMS may deny a supplier’s enrollment for any reason stated in federal statutes that allow that CMS may deny a provider’s or supplier’s enrollment in the Medicare program for the some of the following reasons: Felonies such as insurance fraud and similar crimes.

    REVOCATIONS

    The ALJ found CMS had a legitimate basis because White was convicted of a felony offense that CMS determined to be detrimental to the bests interest of the Medicare program and its beneficiaries.

    Dr. White’s presented equitable arguments to the ALJ that

    1 he self-reported and was not practicing;
    2 using his self-report to deny would encourage other physicians to not self-report,
    3 he has fully complied with the terms of the modified license, and
    eventually he was allowed to practice medicine without limitations.

    The Board affirmed the ALJ’s decision, upholding CMS’ denial of Dr. White’s Medicare enrollment and rejected Dr. White’s argument that the timing of the revocation action by CMS was clearly retaliatory and intended to apply pressure on Dr. White for additional monetary penalties.

    ANALYSIS

    The USDC found CMS’ decisions to deny Dr. White enrollment in Medicare and revoke his privileges, and the subsequent Board’s affirmations were arbitrary and capricious and not supported substantial evidence.

    CMS did not have a legitimate reason to deny enrollment or revoke because the record does not support CMS’ assertions that Dr. White’s 2010 conviction for simple possession of a small amount of cocaine was detrimental to the best interest of the Medicare program and its beneficiaries. The USDC understood the deference it owed to administrative agencies as they adjudicate numerous complex cases before them. Yet, a court may not simply act as a rubber stamp for agency decisions.

    Because CMS failed to provide a reasonable basis for denying Dr. White his enrollment in Medicare or revoking his Medicare privileges, the decision of the Secretary is reversed.

    ZALMA OPINION

    A doctor should never get involved or addicted to illegal substances like Cocaine. The Fact that a doctor self reports his involvement with the drug, was rehabilitated, clean for nine years, and practices medicine legally, does not pose a danger to Medicare as do those doctors who are arrested every year for fraud. The decision of Becerra, the ALJ and the Board was clearly retaliatory and abusive and the USDC had no choice but to reverse the Board and let the doctor continue to practice medicine and charge Medicare for his services. Overreach by the administrative agency was stopped by the court.

    (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
    Permanent Punishment for Conviction for One Ounce of Cocaine Improper Government Overreach and Abuse Reversed Post 4927 Read the full article at https://www.linkedin.com/pulse/permanent-punishment-conviction-one-ounce-cocaine-zalma-esq-cfe-geq1c, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. After Recovery From Cocaine Abuse Dr. Regained License to Practice CMS Refused to Allow Dr. White to Bill Medicare for Services Dr. Stephen White challenged two unfavorable decisions made by the Secretary for the United States Department of Health and Human Services (the “Secretary”) that denied and revoked his Medicare enrollment. The decisions, rendered by the Appellate Division of the Departmental Appeals Board (“Board”), were based on Dr. White’s 2010 guilty plea and deferred prosecution for possession of less than 1 gram of cocaine, which occurred in Texas in 2007. In Stephen White, M.D. v. Xavier Becerra, Secretary for the United States Department of Health and Human Services, No. 2:19-CV-00037-SAB, United States District Court, E.D. Washington (October 28, 2024) the USDC applied entered a judgment reversing the decision of the Secretary [42 U.S.C. § 405(g).] SUMMARY JUDGMENT Summary judgment is appropriate if the movant shows that there is no genuine dispute as to any material fact. BACKGROUND Dr. White is an orthopedic surgeon. In 2006 and 2007, he was arrested and charged with possession of cocaine in Texas. He was able to rehab and become clean of his problem with the drug. The Texas Medical Board revoked his license, but then monitored his recovery and compliance and allowed him to practice again. Dr. White had no violations for nine years following his arrest. He is currently practicing medicine in Washington state and is an enrolled Medicare supplier. The Administrative Law Judge (ALJ) sustained the denial, finding that CMS had a legitimate basis because Dr. White was convicted of a felony offense. The Board affirmed the ALJ’s decision and Dr. White appealed that decision to the USDC. OVERVIEW OF MEDICARE PROGRAM The Medicare program provides health insurance benefits to people sixty-five years old or older and to eligible disabled persons. Suppliers, such as Dr. White, must be enrolled in the Medicare program and be granted billing privileges to be eligible to receive payment for care and services rendered to a Medicare-eligible beneficiary. DENIALS CMS may deny a supplier’s enrollment for any reason stated in federal statutes that allow that CMS may deny a provider’s or supplier’s enrollment in the Medicare program for the some of the following reasons: Felonies such as insurance fraud and similar crimes. REVOCATIONS The ALJ found CMS had a legitimate basis because White was convicted of a felony offense that CMS determined to be detrimental to the bests interest of the Medicare program and its beneficiaries. Dr. White’s presented equitable arguments to the ALJ that 1 he self-reported and was not practicing; 2 using his self-report to deny would encourage other physicians to not self-report, 3 he has fully complied with the terms of the modified license, and eventually he was allowed to practice medicine without limitations. The Board affirmed the ALJ’s decision, upholding CMS’ denial of Dr. White’s Medicare enrollment and rejected Dr. White’s argument that the timing of the revocation action by CMS was clearly retaliatory and intended to apply pressure on Dr. White for additional monetary penalties. ANALYSIS The USDC found CMS’ decisions to deny Dr. White enrollment in Medicare and revoke his privileges, and the subsequent Board’s affirmations were arbitrary and capricious and not supported substantial evidence. CMS did not have a legitimate reason to deny enrollment or revoke because the record does not support CMS’ assertions that Dr. White’s 2010 conviction for simple possession of a small amount of cocaine was detrimental to the best interest of the Medicare program and its beneficiaries. The USDC understood the deference it owed to administrative agencies as they adjudicate numerous complex cases before them. Yet, a court may not simply act as a rubber stamp for agency decisions. Because CMS failed to provide a reasonable basis for denying Dr. White his enrollment in Medicare or revoking his Medicare privileges, the decision of the Secretary is reversed. ZALMA OPINION A doctor should never get involved or addicted to illegal substances like Cocaine. The Fact that a doctor self reports his involvement with the drug, was rehabilitated, clean for nine years, and practices medicine legally, does not pose a danger to Medicare as do those doctors who are arrested every year for fraud. The decision of Becerra, the ALJ and the Board was clearly retaliatory and abusive and the USDC had no choice but to reverse the Board and let the doctor continue to practice medicine and charge Medicare for his services. Overreach by the administrative agency was stopped by the court. (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
    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.
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  • The bottom line is that #Police are more #Violent and more #Corrupt than ANY #Criminal in the United States!

    It is truly RARE to find a criminal that is as dishonest, violent, and eager to harm other people, as is your average Police Officer!

    These people support a CULTURE OF VIOLENCE, corruption, and cover ups!
    And it's NOT "One or two bad apples" as you are told!

    The ENTIRE BUSHEL is rotten to the core

    It looks like the scumbag cop that beat up the guy with cerebral palsy made national news THANKS TO JOHN, at the Civil Rights Lawyer!

    Thanks John!
    I hope your platform GROWS ENORMOUS!

    EVERY POLICE DEPARTMENT IN AMERICA IS JUST AS CORRUPT AS THIS ONE, AND EVERY ONE OF THEM NEED TO BE PROSECUTED BY NON-GOVERNMENT PERSONNEL WHO WILL ACTUALLY PROSECUTE THE CRIMES!

    "Prosecutors" NEVER file charges against Police Officers....
    And they certainly NEVER PROSECUTE POLICE UNDER THE APPROPRIATE STATUTE!

    Which would be TITLE 18 U.S.C. § 241 Conspiracy Against Rights AND
    18 U.S.C. § 242 Deprivation of Rights Under Color of Law

    This is FEDERAL LAW!
    Yet Police are NEVER HELD ACCOUNTABLE for their Criminal actions under these federal statutes because FEDERAL PROSECUTORS refuse to file the charges, making them COMPLICIT in both the crime itself, and in the COVER UP of that crime!

    You want to know WHY POLICE ARE CORRUPT???
    You need not look any further than this FACT!

    And on a side note.... ANY FEDERAL PROSECUTOR who does not file these charges when there is clear and compelling EVIDENCE of the crimes against Americans by Police....

    THAT FEDERAL PROSECUTOR NEEDS TO BE CHARGED UNDER
    TITLE 18 U.S.C. § 241 and 18 U.S.C. § 242 right alongside of the police officer guilty of the crime, AS AN ACCOMPLICE.

    These prosecutors are literally "aiding and abetting" the crimes!

    https://www.nbcnews.com/news/us-news/video-phoenix-police-using-taser-punching-deaf-man-cerebral-palsy-scru-rcna175305
    The bottom line is that #Police are more #Violent and more #Corrupt than ANY #Criminal in the United States! It is truly RARE to find a criminal that is as dishonest, violent, and eager to harm other people, as is your average Police Officer! These people support a CULTURE OF VIOLENCE, corruption, and cover ups! And it's NOT "One or two bad apples" as you are told! The ENTIRE BUSHEL is rotten to the core It looks like the scumbag cop that beat up the guy with cerebral palsy made national news THANKS TO JOHN, at the Civil Rights Lawyer! Thanks John! I hope your platform GROWS ENORMOUS! EVERY POLICE DEPARTMENT IN AMERICA IS JUST AS CORRUPT AS THIS ONE, AND EVERY ONE OF THEM NEED TO BE PROSECUTED BY NON-GOVERNMENT PERSONNEL WHO WILL ACTUALLY PROSECUTE THE CRIMES! "Prosecutors" NEVER file charges against Police Officers.... And they certainly NEVER PROSECUTE POLICE UNDER THE APPROPRIATE STATUTE! Which would be TITLE 18 U.S.C. § 241 Conspiracy Against Rights AND 18 U.S.C. § 242 Deprivation of Rights Under Color of Law This is FEDERAL LAW! Yet Police are NEVER HELD ACCOUNTABLE for their Criminal actions under these federal statutes because FEDERAL PROSECUTORS refuse to file the charges, making them COMPLICIT in both the crime itself, and in the COVER UP of that crime! You want to know WHY POLICE ARE CORRUPT??? You need not look any further than this FACT! And on a side note.... ANY FEDERAL PROSECUTOR who does not file these charges when there is clear and compelling EVIDENCE of the crimes against Americans by Police.... THAT FEDERAL PROSECUTOR NEEDS TO BE CHARGED UNDER TITLE 18 U.S.C. § 241 and 18 U.S.C. § 242 right alongside of the police officer guilty of the crime, AS AN ACCOMPLICE. These prosecutors are literally "aiding and abetting" the crimes! https://www.nbcnews.com/news/us-news/video-phoenix-police-using-taser-punching-deaf-man-cerebral-palsy-scru-rcna175305
    WWW.NBCNEWS.COM
    Video of Phoenix police using a Taser and punching deaf man with cerebral palsy under scrutiny
    Tyron McAlpin was arrested by officers Benjamin Harris and Kyle Sue on Aug. 19 and is charged with two counts of aggravated assault and one count of resisting arrest, all felonies.
    0 Kommentare 0 Anteile 420 Ansichten
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