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.

Debbie Hicks Explosive Day One: Trump and Kennedy Executive Orders Shatter the Status Quo and Redefine America’s Health, Freedom, and Government! BREAKING: Trump and Kennedy unleash a storm of executive orders on day one! Vaccine mandates obliterated, FDA and CDC abolished, bans on toxic ingredients, GMOs, and formal recognition of vaccine injury. A new era of health and freedom rocks America! BOOM: Vaccine Mandates Annihilated! Vaccine mandates are gone! Trump and Kennedy obliterate the mandates with one powerful order, putting an end to years of control by Big Pharma. Medical freedom is back! Americans reclaim the right to choose—no more forced compliance. Personal liberty is non-negotiable! POW! 1986 Vaccine Immunity Law: HISTORY! No more hiding for Big Pharma! Trump and Kennedy have repealed the 1986 Vaccine Injury Act, tearing down the wall of immunity Big Pharma hid behind. Justice is back as citizens regain the right to hold these giants accountable. BANG! Ban on Fluoridation Takes the Nation by Storm! No more fluoride in tap water! Trump and Kennedy’s ban on water fluoridation ends the era of mass medication without consent. Let America drink pure and free! Expect a massive shift toward natural, clean water nationwide. BOOM! FDA, CDC, and FTC Reshuffled—No, Demolished! Trump and Kennedy don’t just reform—they obliterate the FDA, CDC, and FTC, dismantling bureaucracy. This is bureaucracy zero! New, accountable agencies will report to the people and protect health without corporate strings. CRACK! Toxic Ingredients Banned in Food—A Health Revolution! Say goodbye to harmful additives! Artificial dyes, preservatives, and toxins are out of American food. This isn’t a tweak; it’s a food revolution led by Trump and Kennedy to safeguard health. THUNDER! Vaccine Injury and Death Officially Recognized Trump and Kennedy blast through silence, finally acknowledging vaccine injuries and deaths. No more denials or gaslighting. Victims will be heard. Compensation fast-tracked, ensuring justice for those impacted. EXPLOSIVE! GMOs and Toxic Pesticides Banned—America Turns Organic! Trump and Kennedy’s ban on GMOs and pesticides sends a thunderous message: America goes organic. Health is prioritized over profit, and the agricultural sector is forever transformed! FINAL STRIKE: Recognition of Autism-Vaccine Link—A Truth Bomb Trump and Kennedy boldly address the autism-vaccine link, challenging the medical status quo. Independent studies will surge, and programs for affected families will expand, proving this administration champions truth and transparency. THE GRAND FINALE: Abolishing FDA, CDC, FTC—The End of an Era! This is it: the final blistering strike that shatters the status quo. Trump and Kennedy tear down bureaucratic giants, transferring power to the people. America, brace yourself—change is here!

Sodium Fluoride Material Safety Data Sheet Yeah..... Let's dump this TOXIC MINING WASTE into the water supply! We'll make up a story telling the people we are doing for "the health of their teeth" despite the FACT that there is ZERO #EVIDENCE that it helps teeth! But there's sure a lot of actual EVIDENCE it's a toxic POISON.... And it is being dumped into YOUR WATER! There actually ARE beneficial substances in the world.... Like penicillin, when you have a bad infection penicillin may save your life! BUT YOU WOULD NOT DUMP IT INTO THE WATER SUPPLY! NO AMERICAN HAS CONSENTED TO BEING MEDICATED VIA THEIR DRINKING WATER! The addition to this toxin to the water supply is a #Crime against humanity! Just like it would be to add penicillin or any other medication to the water supply! MEDICAL TREATMENT REQUIRES INFORMED CONSENT Well.... No American has consented to being medicated (poisoned) via their water supply! It is time to stop the madness folks! https://apps.mnc.umn.edu/pub/msds/sodium_fluoride.pdf

https://thewashingtonstandard.com/pet-osteoarthritis-injectable-monthly-medication-causing-fatalities-adverse-events/

https://forex-strategy.com/2024/10/01/leading-neuroscientist-attention-deficit-hyperactivity-disorder-does-not-exist-it-was-invented-to-get-kids-on-medication/ Leading neuroscientist: “Attention deficit hyperactivity disorder does not exist, it was invented to get kids on medication #usa #health #adhd #research #medicine #children

Revelation 18:23 23 And the light of a candle shall shine no more at all in thee; and the voice of the bridegroom and of the bride shall be heard no more at all in thee: for thy merchants were the great men of the earth; for by thy sorceries were all nations deceived. [*StrongsGreek*] 5331 pharmakeia far-mak-i'-ah from 5332; medication ("pharmacy"), i.e. (by extension) magic (literally or figuratively):--sorcery, witchcraft. see GREEK for 5332

Just what we need is 2 alcoholics in the White House. Privately, Obama expressed concerns about Kamala Harris: "Throughout Kamala Harris's political career her biggest weakness was her sobriety according to those closest to her. In her first run for the presidency donors were especially reluctant to fund her campaign forcing her out of the race. According to various reports, Obama did NOT want to appoint her to be the Democrat nominee and he lobbied fellow Democrats for a week after Biden withdrew to pick someone else. Anyone who has watched videos of Kamala Harris at events over the past four years can recognize the telltale signs that she is often drunk and/or on mood altering medications. Should Democrats have taken more time to pick a candidate who doesn't struggle with alcoholism and addiction? Can we afford ANOTHER incapacitated president? Of course, Tim Walz is worse given his criminal record related to drunk driving... " https://imgflip.com/i/90yz9p Feel free to copy & paste this in its' entirety and repost on all social media sites, especially facebook!

Barack Obama Talks Out of His ASS Praising Kamala Harris Some would call it talking out both sides of his mouth, but after recent reports to the contrary, I'd say he is talking out of his ass! Privately, Obama expressed concerns about Kamala Harris: "Throughout Kamala Harris's political career her biggest weakness was her sobriety according to those closest to her. In her first run for the presidency donors were especially reluctant to fund her campaign forcing her out of the race. According to various reports, Obama did NOT want to appoint her to be the Democrat nominee and he lobbied fellow Democrats for a week after Biden withdrew to pick someone else. Anyone who has watched videos of Kamala Harris at events over the past four years can recognize the telltale signs that she is often drunk and/or on mood altering medications. Should Democrats have taken more time to pick a candidate who doesn't struggle with alcoholism and addiction? Can we afford ANOTHER incapacitated president? Of course, Tim Walz is worse given his criminal record related to drunk driving... " https://rumble.com/v5btqn6-barack-obama-talks-out-of-his-ass-praising-kamala-harris.html

Protected from the negatives of sitting for six or more hours a day. The World Health Organization on Thursday issued warnings on falsified diabetes and weight-loss drugs highlights significant concerns about the safety and efficacy of these medications products detected in Brazil, the U.K. and the United States.

WINNING THE FLUORIDE FIGHT - #SOLUTIONSWATCH FIRST OF ALL.... #Fluoride is NOT a "medicine" Fluoride is a TOXIC CHEMICAL WASTE PRODUCT OF THE MINING INDUSTRY! I dare you to look up the #MSDS of Fluoride! It's so TOXIC in fact, that people who handle it are REQUIRED to wear a "moon suit" (Like the suit NASA fakers wore when they FAKED the moon landing) Fluoride is so toxic that 100% of your body must be covered up, as forced air is pumped into the suit, ensuring that none of this TOXIC CHEMICAL WASTE can get into the suit via the air supply There are lots of people who claim that we have people and children consuming "Uncontrolled amounts of medication" via their drinking water... which would be true IF fluoride was a medication... IT'S NOT! It's a TOXIC waste product of mining But let's say that fluoride actually is a "medicine" How many "medicines" are dumped into the WATER SUPPLY so that people who drink water all day long every day consume uncontrolled amounts of it??? That is INSANITY! But fluoride is NOT A "MEDICINE" it's a toxic by-product of the mining industry!!! So toxic in fact, that it's treated JUST LIKE "nuclear waste" So when you make your newborn baby a bottle, it has TOXIC CHEMICAL WASTE in the water you are using! And that toxic chemical waste WILL destroy your ability to THINK and to rationalize. It will make YOU into an "obedient #Slave" And THAT is exactly why it's in YOUR WATER SUPPLY! The people who put it there are Criminals who are poisoning mankind! WHY IS IT..... Do you think.... That when discussing this subject I ALWAYS think about the stories of the #Jews who POISONED PEOPLE'S WELLS in days gone by??? WHY would I conflate these two things do you suppose? https://www.bitchute.com/video/819V6ZaR67r9/