• Gold Price Will Shatter Records In 2025: This Is The Target | Jeff Christian

    https://www.youtube.com/watch?v=9yV6NUALPiw&list=TLPQMjQxMTIwMjSTuJMrhuK4xw&index=4
    Gold Price Will Shatter Records In 2025: This Is The Target | Jeff Christian https://www.youtube.com/watch?v=9yV6NUALPiw&list=TLPQMjQxMTIwMjSTuJMrhuK4xw&index=4
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  • 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
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  • My name is Jake Lang & I have been a January 6 Hostage - incarcerated & tortured without a trial for 3 years, 10 months and 5 days by the Deepstate!

    I will not accept a pardon unless ALL Jan 6 Prisoners are pardoned.

    The 1561+ January 6 Political Prisoners are unanimously calling upon President Trump to SAVE OUR LIVES & follow his heart: Pardon All J6ers on Day One

    NO MAN LEFT BEHIND TO ROT IN THE GULAG!

    We have drafted the J6 Day One Freedom Petition ( J6Pardons.com ) that has been signed by tens of thousands of red blooded Americans, including Conservative Luminaries:

    Jim Hoft, Laura Loomer, Darren Beattie, Diamond & Silk, Grant Stinchfield, Brandon Straka, Cara Castronuova, Wayne Allyn Root, Ann Vandersteel, Doug Billings, Jeff Crouere, Behizy, Matt Wallce, Couy Griffin, Treniss Evans, David Sumrall & Suzzane Monk

    The weaponization of the DOJ has gone too far, and destroyed thousands of lives with an overzealous political persecution of Trump supporters.

    Trump knows how it feels to be railroaded, denied due process & an impartial jury. To be convicted by the corrupt media before you ever step foot in court.

    Every Jan 6er was entrapped by our own Federal Government at the Capitol, a clear set up to paint Trump & his supporters as domestic terrorists!!

    The hundreds of patriotic men who have assault charges (590 out of 1561 defendants) such as myself - were forced to defend our own lives & the lives of the unarmed women and elderly around us.

    The Capitol Police murdered a young defenseless woman Roseanne Boyland, a 38 year old angel from Georgia in my arms. After this many men including myself took up a serious defensive position.

    The numerous award winning documentaries on J6 prove that we were NOT the aggressors, but responded as brave American men do to oppression & violence: we stood our ground & defended those around us.

    Nearly 4 years I have traded tears and prayers with my brothers in the Gulag, getting to know each and every man & see his Godly character -

    I can unequivocally say this crop of patriots & Christians are the BEST AMERICANS WE HAVE: they are bold and brave, kind and concerned fathers & husbands, leaders and lovers of God and Country.

    Unbreakable, indomitable, unrelenting 1776 patriots who would die to defend our Constitution without moments hesitation.

    Humble hard workers, military veterans & school teachers. Bus drivers, doctors, Olympic athletes, NFL players, Broadway stars and missionary servants of the Lord.

    Carpenters, plumbers, roofers, electricians, fathers, husbands: Man amongst men.

    This outrageous stain on American history, similar to the Japanese internment camps in World War II, has gone on long enough. Its time to set free the captives, and break the shackles of two tiered justice.

    Its time to release, pardon & fully expunge / erase the records of every single January 6 Hostage. Point blank period.

    History calls us to this moment of National Reconciliation, the American people have all but lost their faith in the judicial system watching Trump & the J6 witch hunt continue for 4 long years. We need to restore belief & trust in American jurisprudence.

    The immediate release of the Jan 6ers is where we start this battle to revive our degenerated institutions that used to be sacred.

    We are trusting the new MAGA Attorney General will also put an end to the Weaponized DOJ and immediately HALT all new J6 investigations & arrests, and DISMISS all current pending cases.

    How many J6 grandmothers need to be ripped out of their homes at gunpoint by a tyrannical FBI GESTAPO squadron and railroaded into federal prisons before we STOP THIS MADNESS!?!

    My conscious is clear before the Savior of man: that just as blanket pardons were issued after the Civil War to restore national unity, we too should be looking at this national healing moment with reverence & earnest expectations!

    President Trump will not let us down, we stand behind you Mr. President!

    NOT A SINGLE J6ER WAS GIVEN A FAIR TRIAL!!!

    J6Pardons.com to sign the official J6 Day One Freedom Petition

    #MAGA #FULLPARDONS #BREAKEVERYCHAIN #FREEATLAST #JANUARY20TH #INAUGURATION #LIBERATIONDAY
    https://x.com/JakeLangJ6/status/1859657832951632228?t=Ba2gzLPyrEytXhVvOHtSLw&s=09
    My name is Jake Lang & I have been a January 6 Hostage - incarcerated & tortured without a trial for 3 years, 10 months and 5 days by the Deepstate! I will not accept a pardon unless ALL Jan 6 Prisoners are pardoned. The 1561+ January 6 Political Prisoners are unanimously calling upon President Trump to SAVE OUR LIVES & follow his heart: Pardon All J6ers on Day One NO MAN LEFT BEHIND TO ROT IN THE GULAG! We have drafted the J6 Day One Freedom Petition ( J6Pardons.com ) that has been signed by tens of thousands of red blooded Americans, including Conservative Luminaries: Jim Hoft, Laura Loomer, Darren Beattie, Diamond & Silk, Grant Stinchfield, Brandon Straka, Cara Castronuova, Wayne Allyn Root, Ann Vandersteel, Doug Billings, Jeff Crouere, Behizy, Matt Wallce, Couy Griffin, Treniss Evans, David Sumrall & Suzzane Monk The weaponization of the DOJ has gone too far, and destroyed thousands of lives with an overzealous political persecution of Trump supporters. Trump knows how it feels to be railroaded, denied due process & an impartial jury. To be convicted by the corrupt media before you ever step foot in court. Every Jan 6er was entrapped by our own Federal Government at the Capitol, a clear set up to paint Trump & his supporters as domestic terrorists!! The hundreds of patriotic men who have assault charges (590 out of 1561 defendants) such as myself - were forced to defend our own lives & the lives of the unarmed women and elderly around us. The Capitol Police murdered a young defenseless woman Roseanne Boyland, a 38 year old angel from Georgia in my arms. After this many men including myself took up a serious defensive position. The numerous award winning documentaries on J6 prove that we were NOT the aggressors, but responded as brave American men do to oppression & violence: we stood our ground & defended those around us. Nearly 4 years I have traded tears and prayers with my brothers in the Gulag, getting to know each and every man & see his Godly character - I can unequivocally say this crop of patriots & Christians are the BEST AMERICANS WE HAVE: they are bold and brave, kind and concerned fathers & husbands, leaders and lovers of God and Country. Unbreakable, indomitable, unrelenting 1776 patriots who would die to defend our Constitution without moments hesitation. Humble hard workers, military veterans & school teachers. Bus drivers, doctors, Olympic athletes, NFL players, Broadway stars and missionary servants of the Lord. Carpenters, plumbers, roofers, electricians, fathers, husbands: Man amongst men. This outrageous stain on American history, similar to the Japanese internment camps in World War II, has gone on long enough. Its time to set free the captives, and break the shackles of two tiered justice. Its time to release, pardon & fully expunge / erase the records of every single January 6 Hostage. Point blank period. History calls us to this moment of National Reconciliation, the American people have all but lost their faith in the judicial system watching Trump & the J6 witch hunt continue for 4 long years. We need to restore belief & trust in American jurisprudence. The immediate release of the Jan 6ers is where we start this battle to revive our degenerated institutions that used to be sacred. We are trusting the new MAGA Attorney General will also put an end to the Weaponized DOJ and immediately HALT all new J6 investigations & arrests, and DISMISS all current pending cases. How many J6 grandmothers need to be ripped out of their homes at gunpoint by a tyrannical FBI GESTAPO squadron and railroaded into federal prisons before we STOP THIS MADNESS!?! My conscious is clear before the Savior of man: that just as blanket pardons were issued after the Civil War to restore national unity, we too should be looking at this national healing moment with reverence & earnest expectations! President Trump will not let us down, we stand behind you Mr. President! NOT A SINGLE J6ER WAS GIVEN A FAIR TRIAL!!! J6Pardons.com to sign the official J6 Day One Freedom Petition #MAGA #FULLPARDONS #BREAKEVERYCHAIN #FREEATLAST #JANUARY20TH #INAUGURATION #LIBERATIONDAY https://x.com/JakeLangJ6/status/1859657832951632228?t=Ba2gzLPyrEytXhVvOHtSLw&s=09
    0 Comments 0 Shares 2K 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.
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  • THE ILLUMINATI RECORDS - Truth Movement Pioneer Anthony J Hilder
    https://rumble.com/vnxfb2-the-illuminati-records-myron-fagan-anthony-j-hilder.html
    The Illuminati Records ...Major NEW Release about Truth Movement Pioneer ANTHONY J HILDER.... ..Produced by Olly Marshall of MARSHALLFILM.COM - THE ILLUMINATI RECORDS... A brief account of the Illuminati conspiracy from the roots of the original Illuminati expose by Myron Fagan and Anthony J. Hilder. Anthony J Hilder, Ted Gunderson, Gary Richard Arnold, Damien Chapa, Dr Stan Monteith. Hard Hitting film and these are some of the major players in the World Wide Wakeup.
    THE ILLUMINATI RECORDS - Truth Movement Pioneer Anthony J Hilder https://rumble.com/vnxfb2-the-illuminati-records-myron-fagan-anthony-j-hilder.html The Illuminati Records ...Major NEW Release about Truth Movement Pioneer ANTHONY J HILDER.... ..Produced by Olly Marshall of MARSHALLFILM.COM - THE ILLUMINATI RECORDS... A brief account of the Illuminati conspiracy from the roots of the original Illuminati expose by Myron Fagan and Anthony J. Hilder. Anthony J Hilder, Ted Gunderson, Gary Richard Arnold, Damien Chapa, Dr Stan Monteith. Hard Hitting film and these are some of the major players in the World Wide Wakeup.
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  • Bad Faith Set Up Fails

    Read the full article at https://www.linkedin.com/pulse/bad-faith-set-up-fails-barry-zalma-esq-cfe-jllxc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts.
    Inadequate Information Made Refusal to Pay Policy Limits Not Bad Faith

    INADEQUATE MEDICAL AUTHORIZATION USED TO CAUSE INSURER TO REFUSE SETTLEMENT DEMAND

    Post 4930

    Kara Flick appealed from the judgment after a jury rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. Flick contends the judgment should be reversed due to juror misconduct.

    In KARA FLICK v. UNITED SERVICES AUTOMOBILE ASSOCIATION, B330507, California Court of Appeals, Second District, Sixth Division (November 5, 2024) the Court of Appeals resolved the dispute.

    FACTUAL HISTORY

    After sustaining injuries in an automobile accident caused by Francisco Reyes, Jr., Flick had her attorney send Reyes's insurer, the United Services Automobile Association (USAA), a letter explaining the severity of her injuries and an authorization for the release of her medical records. Flick's attorney followed up with a settlement demand two months later, requesting that USAA pay Flick the entirety of Reyes's $100,000 policy limit in exchange for a release of liability. Attached to the demand was a single medical record from Flick's neurologist.

    USAA investigated Flick's claim and determined it did not have sufficient information to accept or reject her demand. Flick then filed a personal injury lawsuit against Reyes. The jury found in her favor and awarded nearly $1.7 million in damages.

    Flick, with an assignment from the Reyes, sued USAA for breach of contract and breach of the implied covenant of good faith and fair dealing.

    TRIAL

    At trial, a USAA claims adjustor admitted that Reyes was fully at fault for the accident with Flick. Reyes could therefore be exposed to liability in excess of his policy limits-if Flick provided sufficient documentation to support her claim.

    USAA's expert on insurance claims handling and another of its claims service managers both agreed with the supervisor that Flick's authorization was invalid and inadequate to allow USAA to obtain Flick's medical records.

    USAA needed additional records before it could determine the value of Flick's claim. Those records could have included the medical bills Flick provided to her own insurance company, the multiple doctor's notes she had excusing her from work, or the thumb drive recording her purported speech problems, all of which were entered into evidence at her personal injury trial. Because they were not provided to USAA, it was "very difficult to place a value on" Flick's claim.

    Flick's expert testified that USAA's handling of the settlement demand "was clearly unreasonable."

    Flick also did not respond to USAA's requests for additional information.

    By a vote of nine to three, the jury found that Flick did not make a reasonable settlement demand of USAA and rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. The trial court polled the jury, and each juror confirmed their vote.

    DISCUSSION

    The Court of Appeals concluded the trial court did not abuse its discretion in denying Flick's new trial motion. USAA successfully rebutted the presumption of prejudice by showing there is no reasonable probability that the juror, D.C.'s misconduct by not explaining he did not hear all of the adjuster's testimony, actually harmed Flick.

    Much of the adjustor's testimony consisted of facts regarding his communications with Flick's attorney - facts that were undisputed.

    What was disputed-whether Flick's settlement demand was reasonable-was the subject of other witness testimony, including USAA's expert on insurance claims handling, its supervising claims service manager, Flick's personal injury attorney, and her expert witness on insurance claims handling.

    What the admitted evidence showed was that D.C. confirmed multiple times that he voted that Flick did not make a reasonable settlement demand:

    Based on this record there was no reasonable probability that D.C.'s alleged juror misconduct actually harmed Flick.

    ZALMA OPINION

    The tort of bad faith arose from abuse by insurers on those they insured. Since its adoption in California about three quarters of a century ago, the abuse has been turned on to insurers. Ms. Flick's counsel placed a demand for settlement on USAA that it could not reasonably and in good faith to its insured, Reyes, because it was incomplete and inadequately supported and forced Flick and Reyes go through a trial where she received an uncollectible judgment against Reyes in hopes of a gigantic bad faith judgment. After much litigation and USAA spending a great deal to defend itself she received the $100,000 policy limit. USAA was punished but neither Flick nor her lawyers profited from the scheme or the appeal.

    (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.

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    Go to the Insurance Claims Library – https://lnkd.in/gwEYk
    Bad Faith Set Up Fails Read the full article at https://www.linkedin.com/pulse/bad-faith-set-up-fails-barry-zalma-esq-cfe-jllxc, see the full video at and at and at https://zalma.com/blog plus more than 4900 posts. Inadequate Information Made Refusal to Pay Policy Limits Not Bad Faith INADEQUATE MEDICAL AUTHORIZATION USED TO CAUSE INSURER TO REFUSE SETTLEMENT DEMAND Post 4930 Kara Flick appealed from the judgment after a jury rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. Flick contends the judgment should be reversed due to juror misconduct. In KARA FLICK v. UNITED SERVICES AUTOMOBILE ASSOCIATION, B330507, California Court of Appeals, Second District, Sixth Division (November 5, 2024) the Court of Appeals resolved the dispute. FACTUAL HISTORY After sustaining injuries in an automobile accident caused by Francisco Reyes, Jr., Flick had her attorney send Reyes's insurer, the United Services Automobile Association (USAA), a letter explaining the severity of her injuries and an authorization for the release of her medical records. Flick's attorney followed up with a settlement demand two months later, requesting that USAA pay Flick the entirety of Reyes's $100,000 policy limit in exchange for a release of liability. Attached to the demand was a single medical record from Flick's neurologist. USAA investigated Flick's claim and determined it did not have sufficient information to accept or reject her demand. Flick then filed a personal injury lawsuit against Reyes. The jury found in her favor and awarded nearly $1.7 million in damages. Flick, with an assignment from the Reyes, sued USAA for breach of contract and breach of the implied covenant of good faith and fair dealing. TRIAL At trial, a USAA claims adjustor admitted that Reyes was fully at fault for the accident with Flick. Reyes could therefore be exposed to liability in excess of his policy limits-if Flick provided sufficient documentation to support her claim. USAA's expert on insurance claims handling and another of its claims service managers both agreed with the supervisor that Flick's authorization was invalid and inadequate to allow USAA to obtain Flick's medical records. USAA needed additional records before it could determine the value of Flick's claim. Those records could have included the medical bills Flick provided to her own insurance company, the multiple doctor's notes she had excusing her from work, or the thumb drive recording her purported speech problems, all of which were entered into evidence at her personal injury trial. Because they were not provided to USAA, it was "very difficult to place a value on" Flick's claim. Flick's expert testified that USAA's handling of the settlement demand "was clearly unreasonable." Flick also did not respond to USAA's requests for additional information. By a vote of nine to three, the jury found that Flick did not make a reasonable settlement demand of USAA and rejected her claims for breach of contract and breach of the implied covenant of good faith and fair dealing. The trial court polled the jury, and each juror confirmed their vote. DISCUSSION The Court of Appeals concluded the trial court did not abuse its discretion in denying Flick's new trial motion. USAA successfully rebutted the presumption of prejudice by showing there is no reasonable probability that the juror, D.C.'s misconduct by not explaining he did not hear all of the adjuster's testimony, actually harmed Flick. Much of the adjustor's testimony consisted of facts regarding his communications with Flick's attorney - facts that were undisputed. What was disputed-whether Flick's settlement demand was reasonable-was the subject of other witness testimony, including USAA's expert on insurance claims handling, its supervising claims service manager, Flick's personal injury attorney, and her expert witness on insurance claims handling. What the admitted evidence showed was that D.C. confirmed multiple times that he voted that Flick did not make a reasonable settlement demand: Based on this record there was no reasonable probability that D.C.'s alleged juror misconduct actually harmed Flick. ZALMA OPINION The tort of bad faith arose from abuse by insurers on those they insured. Since its adoption in California about three quarters of a century ago, the abuse has been turned on to insurers. Ms. Flick's counsel placed a demand for settlement on USAA that it could not reasonably and in good faith to its insured, Reyes, because it was incomplete and inadequately supported and forced Flick and Reyes go through a trial where she received an uncollectible judgment against Reyes in hopes of a gigantic bad faith judgment. After much litigation and USAA spending a great deal to defend itself she received the $100,000 policy limit. USAA was punished but neither Flick nor her lawyers profited from the scheme or the appeal. (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
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  • 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
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    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 President Trump Effect: Just few days since his Election Win:

    Appoints the first-ever woman as chief of staff.

    The Taliban signals a wish to be removed from the terrorist list.

    Putin announces the West is no longer viewed as an enemy.

    Mexico discourages large caravans from heading to the U.S. border.

    New York halts food vouchers for illegal immigrants.

    China expresses a desire for peaceful coexistence with America.

    European Union leaders announce plans to prioritize

    American gas over Russian supplies.

    Hamas calls for an end to the war.

    The stock and crypto markets are soaring to new records.
    Nov 10, 2024, 5:35 PM
    https://truthsocial.com/@candijo0475/posts/113461044882250493
    The President Trump Effect: Just few days since his Election Win: ▪️ Appoints the first-ever woman as chief of staff. ▪️ The Taliban signals a wish to be removed from the terrorist list. ▪️ Putin announces the West is no longer viewed as an enemy. ▪️ Mexico discourages large caravans from heading to the U.S. border. ▪️ New York halts food vouchers for illegal immigrants. ▪️ China expresses a desire for peaceful coexistence with America. ▪️ European Union leaders announce plans to prioritize ▪️ American gas over Russian supplies. ▪️ Hamas calls for an end to the war. ▪️ The stock and crypto markets are soaring to new records. Nov 10, 2024, 5:35 PM https://truthsocial.com/@candijo0475/posts/113461044882250493
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  • .....OPEN THE RECORDS!!!!!...
    https://www.youtube.com/shorts/bOSfyHQzxrU
    .....OPEN THE RECORDS!!!!!... https://www.youtube.com/shorts/bOSfyHQzxrU
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  • Gun violence breaks ‘new records’ across Ontario, GTA! Jooyoung Lee, a professor of sociology at the University of Toronto, told CBC News that Trudeau's ‘handgun freeze’ has done little to combat violent crime. Most of those firearms are smuggled from the U.S.
    #NoMoreLiberalsAndNDP
    #SayingTheQuietPartOutLoud
    #resigntrudeau
    #JustSayNoMore
    https://www.rebelnews.com/gun_violence_breaks_new_records_across_ontario_gta
    Gun violence breaks ‘new records’ across Ontario, GTA! Jooyoung Lee, a professor of sociology at the University of Toronto, told CBC News that Trudeau's ‘handgun freeze’ has done little to combat violent crime. Most of those firearms are smuggled from the U.S. 🇨🇦 #NoMoreLiberalsAndNDP 🇨🇦 🇨🇦 #SayingTheQuietPartOutLoud 🇨🇦 🇨🇦 #resigntrudeau 🇨🇦 🇨🇦 #JustSayNoMore 🇨🇦 https://www.rebelnews.com/gun_violence_breaks_new_records_across_ontario_gta
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    Gun violence breaks ‘new records’ across Ontario, GTA
    Jooyoung Lee, a professor of sociology at the University of Toronto, told CBC News that Trudeau's ‘handgun freeze’ has done little to combat violent crime. Most of those firearms are smuggled from the U.S.
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