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.

General Mike Flynn @GenFlynn Democrats, if you’re wondering why America voted for Trump, allow me to explain: The truth is, the American People are sick of your shit. You ruined our nation and our culture. You openly mocked, belittled, and discriminated us, then called us racist, misogynist, Nazis when we started noticing. You defiled and corrupted all of our great institutions, to include the media, social media, tech, academia, intelligence, health, pharma, Hollywood, entertainment, sports, EVERYTHING! You weaponized every aspect of American life, and used it to push your insane far-Left agenda down our throats. You told us Trump was a Russian asset that was going to start WW3 and would be worse than Hitler. Then you used that as an excuse to justify hatred towards Trump supporters and to riot in the streets. You used it as an excuse to obstruct and ruin Trump’s entire first term, and it turned out it was all a lie. Then during Covid, you demanded we all be forced to take medical experimentation without testing. You wanted dissenters locked in prison. You wanted children taken from their anti-vax parents. You wanted the anti-vax in camps. You were rooting for our deaths. Then it turned out you were wrong about everything from the man-made origin, to masks, to vaccines, to social distancing, to ivermectin, to HCQ, to natural immunity, and everything in between. Then during Ukraine, you told us that Ukraine was a bastion of Democracy, and that they desperately needed all of our tax dollars. Then it turned out that Ukraine is one of the most corrupt nations in the world, with literal Nazi military forces, and it was actually just a money laundering operation to steal from the American taxpayer. You want to defend Ukraine’s borders more than our own. You sent hundreds of billions of dollars on the other side of the planet, while Americans are suffering, all based on more lies. Then there’s the whole Epstein, Diddy, human-trafficking element. You all told us VEHEMENTLY that human-trafficking was a myth, you told us the border was secure, and you told us that anyone who questioned it was an irredeemable & deplorable conspiracy theorist (and a piece of garbage). You said anyone who watched “Sound of Freedom” was a QAnon extremist and threat to democracy. Then it turned out to be true, and the elites really are engaged in unspeakable crimes against children. After you all told us for decades this was not true. You covered up the most heinous crimes imaginable, for political gain. I could do this for days, but I think you get the point. The American People are awake to the scam and the true evil going on around us, and we are not going to stand for it anymore. So we hired Donald J. Trump and his team of Patriots to rectify the situation, and bring America back to her greatness. This is the reality of the situation. You are the bad guys, and you have been deceived. The sooner you wake up to it, the sooner you can join us in repairing this nation. Or you can choose to deny reality, and spend the rest of your lives consumed by hate, based on lies. The choice is yours. Signed: A True American Patriot @realDonaldTrump Thank you for your courage and for standing in the fire for America and all of humanity. God Bless America 🙏🏼🇺🇸 6:59 AM · Nov 10, 2024 · 691K Views

Absolutely it is! This is a fantastic documentary that could be 110% better if it's creators were aware of (Or did not hide) the FACT that the earth is an ENCLOSED SYSTEM, and is FLAT & STATIONARY! If you believe in what your bible tells you, I want you to open to PAGE 1, GENESIS 1, and read down to verse 10! YHWH "separated the waters from the waters." Genesis 6 And God said, Let there be a firmament in the midst of the waters, and let it divide the waters from the waters. Genesis 7 And God made the firmament, and divided the waters which were under the firmament from the waters which were above the firmament: and it was so. There are several misleading parts within this documentary, like when the man claims that during creation "We now have a water ball in space." WHERE IS THAT IN THE TEXT??? No folks, "space" does not exist, #NASA is a Satanic organization of deception, and the earth is FLAT and STATIONARY just like the bible tells you it is! COUNT THE NUMBER OF TIMES YOUR BIBLE SAYS "The earth shall not be moved" Go and count them! Count how many times your bible says the earth has "foundations." This documentary would be perfect if it told the TRUTH about our earth being a flat and stationary PLANE and the Sun, Moon, and stars are "Lights in the sky" (within the firmament) just like the bible tells us it is. I respect the creators of this documentary, they could just be brainwashed into believing in "Space" and all of that nonsense, just like the rest of us were! But I have found that Hollywood and "Science so-called" always uses deception in this area. There is no demonstrable "curvature" to the earth's surface. This ALONE proves without a shadow of a doubt that the earth is flat! Don't believe me? I challenge you to "Prove the #Globe" you believe in! That is what I tried to do, and is why now I know the TRUTH.... That there is no proof to the claim the earth is a sphere! It's all a Satanic LIE. It is likely "The great delusion" spoken of in your bible! Have a blessed day and READ YOUR BIBLE! Go check out Rob Skiba's "Testing the Globe" website, there is a lot of information there! Most importantly though... PRAISE YHWH and admire His perfect Creation! A living Testament to His greatness and power! Walk in His statutes and be humble! https://youtu.be/UM82qxxskZE

TELL IT HOW IT IS GENERAL FLYNN!!! Democrats, if you’re wondering why America voted for Trump, allow me to explain: The truth is, the American People are sick of your shit. You ruined our nation and our culture. You openly mocked, belittled, and discriminated us, then called us racist, misogynist, Nazis when we started noticing. You defiled and corrupted all of our great institutions, to include the media, social media, tech, academia, intelligence, health, pharma, Hollywood, entertainment, sports, EVERYTHING! You weaponized every aspect of American life, and used it to push your insane far-Left agenda down our throats. You told us Trump was a Russian asset that was going to start WW3 and would be worse than Hitler. Then you used that as an excuse to justify hatred towards Trump supporters and to riot in the streets. You used it as an excuse to obstruct and ruin Trump’s entire first term, and it turned out it was all a lie. Then during Covid, you demanded we all be forced to take medical experimentation without testing. You wanted dissenters locked in prison. You wanted children taken from their anti-vax parents. You wanted the anti-vax in camps. You were rooting for our deaths. Then it turned out you were wrong about everything from the man-made origin, to masks, to vaccines, to social distancing, to ivermectin, to HCQ, to natural immunity, and everything in between. Then during Ukraine, you told us that Ukraine was a bastion of Democracy, and that they desperately needed all of our tax dollars. Then it turned out that Ukraine is one of the most corrupt nations in the world, with literal Nazi military forces, and it was actually just a money laundering operation to steal from the American taxpayer. You want to defend Ukraine’s borders more than our own. You sent hundreds of billions of dollars on the other side of the planet, while Americans are suffering, all based on more lies. Then there’s the whole Epstein, Diddy, human-trafficking element. You all told us VEHEMENTLY that human-trafficking was a myth, you told us the border was secure, and you told us that anyone who questioned it was an irredeemable & deplorable conspiracy theorist (and a piece of garbage). You said anyone who watched “Sound of Freedom” was a QAnon extremist and threat to democracy. Then it turned out to be true, and the elites really are engaged in unspeakable crimes against children. After you all told us for decades this was not true. You covered up the most heinous crimes imaginable, for political gain. I could do this for days, but I think you get the point. The American People are awake to the scam and the true evil going on around us, and we are not going to stand for it anymore. So we hired Donald J. Trump and his team of Patriots to rectify the situation, and bring America back to her greatness. This is the reality of the situation. You are the bad guys, and you have been deceived. The sooner you wake up to it, the sooner you can join us in repairing this nation. Or you can choose to deny reality, and spend the rest of your lives consumed by hate, based on lies. The choice is yours. Signed: A True American Patriot @realDonaldTrump Thank you for your courage and for standing in the fire for America and all of humanity. God Bless America 🙏🏼🇺🇸 6:59 AM · Nov 10, 2024 · https://x.com/GenFlynn/status/1855580973028540483

TO WATCH MY FIRST VIDEO IN THE NEW SITE I'M TESTING FOR FUTURE POSTING, CLICK ON THE FOLLOWING LINK (NOT ON THE PHOTO)-----> https://gorf.com/modal/tree-view/wQJWXM5x0Bop

German government disappearing after millions of people in Germany began protesting against the far-right, a vote of confidence is planned for January, possibly paving the way for snap elections of the first three-way coalition government is now history, After the Wars.

Democracy is two wolves and a lamb voting on what to eat. Liberty is a well-armed lamb contesting the vote.

J6’ers are still suffering in jail for protesting a fraudulent election. Think about them. Trump gives them hope. CommieHoe is a death sentence to these innocent people.

https://medforth.biz/64-violent-far-left-activists-arrested-in-paris-protesting-anti-trans-book/

Bird Flu: Separating Fact from Fiction and True Danger from Fear-mongering https://youtu.be/DAYPF2eiwr0 The current variant of Bird Flu appears to be a product of human agency, including mass vaccination of poultry with leaky vaccines and possible genetic manipulation in US and Chinese government funded laboratories. Thus, as was the case with the emergence of SARS-CoV-2, official narratives about origins, spread, testing, and risk mitigation should be subjected to rigorous examination. Independent investigation, ongoing research, and analysis are critical to understanding the reality of this pathogen and the purported threat it poses to animal and human health.