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February 02, 2022
Fraud by Licensed Paramedic & Criminal Conduct Can Result in Removal of License

Failure in Obligation to Self-Report Needs to be Proved

Read the full article at https://www.linkedin.com/pulse/fraud-licensed-paramedic-criminal-conduct-can-result-barry and https://zalma.com/blog plus more than 4050 posts.

Kevin A. Imhof (“Imhof”) appealed from the decision of the Board of Medical Licensure and Discipline (hereinafter the “Board”) finding that he engaged in unprofessional conduct. A final order of the Board (hereinafter the “Order”) found that Imhof, a Board-licensed paramedic, engaged in conduct constituting crimes substantially related to the practice of medicine; engaged in dishonorable, unethical, or other conduct likely to deceive, defraud, or harm the public; and wilfully failed to report certain conduct in a timely fashion. In Kevin Imhof v. Delaware Board Of Medical Licensure And Discipline, C. A. No. K21A-06-004 NEP, Superior Court of Delaware (January 26, 2022) a Delaware appellate court resolved some of the issues raised by the appeal.

FACTUAL HISTORY

In 2019, Imhof completed a questionnaire and underwent a pre-employment polygraph test as part of his application for a position with the Delaware State Police. On the questionnaire and during the test, Imhof made certain admissions, including the following:

he had accessed his former wife’s social media accounts, emails, and text messages without her permission during the second half of 2018;

he had driven to his former wife’s residence and had watched through an outside window while she and another individual engaged in sexual activity;

he had trespassed into his former wife’s house and committed lewd acts within; and

he had committed acts of vandalism by keying his former wife’s automobile, and then his own-to conceal his actions-and, thereafter, had filed a fraudulent insurance claim related to such damages.

In consequence, the Delaware State Police made a criminal referral. In September 2019, Imhof entered guilty pleas to the offenses of Criminal Mischief, Violation of Privacy, and Trespass with Intent to Peer or Peep. The remaining charges were dropped. Imhof did not inform the Board of the criminal charges or his convictions until he applied to renew his license in May 2020.

The hearing officer, after reviewing all the submitted and testimonial evidence, issued a written recommendation to the Board and recommended discipline. The hearing officer concluded that Imhof had violated the three statutory provisions and that by pleading guilty to two crimes the Board has determined to be “substantially related to medicine,” Imhof violated 24 Del. C. § 1731(b)(2); that Imhof had engaged in “dishonorable, unethical, or other conduct likely to deceive, defraud, or harm the public” in violation of 24 Del. C. § 1731(b)(3); and that Imhof’s report of his criminal conduct “was grossly untimely” in that he had waited nine months following his arrest to report the matter to the Board, thus violating 24 Del. C. § 1731(b)(14).

The hearing officer’s recommended discipline included suspension of Imhof’s Paramedic license.

DISCUSSION

Hearing Officer’s Recommendation

Administrative agencies operate less formally than courts of law. Accordingly, rules of evidence do not strictly apply to administrative hearings. The Board may hear all evidence which could conceivably throw light on the controversy. Only when the hearsay is incompetent will the Board’s reliance on such testimony be deemed an abuse of discretion. However, the Board should apply the rules of evidence insofar as practicable.

As to the evidentiary issue, Imhof’s conduct reported to the polygraph operator, at times, overstretched the bounds of relevance to the proceeding. Therefore, to the extent that this evidence was improperly admitted, the admission constituted harmless error.

The Board’s “Case Decision”

Delaware statutes find that unprofessional conduct is conduct that would constitute a crime substantially related to the practice of medicine. The Board has the power and duty to designate crimes that it deems substantially related to the practice of medicine. In addition, the Court has previously found that the Board followed the proper procedures in enacting Regulation 15.

Imhof’s primary argument regarding the “case decision” is that his conduct was not substantially related to the practice of medicine. However, two of Imhof’s pled offenses, Violation of Privacy and Trespassing with Intent to Peer or Peep, are listed among the crimes substantially related to the practice of medicine found in Regulation 15. Thus, there is no dispute that Imhof pled guilty to two of the listed crimes.

The Board, under its powers and duties, “shall” and did designate certain crimes to be substantially related to the practice of medicine and went through the proper administrative procedures to do so by enacting Regulation 15. There was substantial evidence both through Imhof’s own admissions in his questionnaire and polygraph, and by means of his guilty pleas, to find that the crimes were committed. Hence, by the authority of Regulation 15, the crimes are deemed “substantially related to the practice of medicine.”

The Board has promulgated a list of “dishonorable or unethical” conduct under Regulation 8. According to Regulation 8, “[t]he phrase ‘dishonorable or unethical conduct likely to deceive, defraud, or harm the public’ … shall include, but not be limited to . . . [a]ny . . . act tending to bring discredit upon the profession.” It is not difficult to perceive how the admitted wrongful conduct and actions would bring discredit to the profession.

The appellate court concluded that there was substantial evidence to support the finding by the Board that Imhof violated the statute by committing acts likely to “harm the public” and “discredit” the profession.

Without reversing the Board on the requirement to self-report, the court remanded the matter to the Board for further consideration of whether a wilful failure to report has been established and to consider whether the discipline imposed should be modified in light of any additional consideration of these matters by the Board.

The Court affirmed the Board’s finding that Imhof engaged in conduct constituting crimes substantially related to the practice of medicine in violation of statute and that he engaged in dishonorable, unethical, or other conduct likely to deceive, defraud, or harm the public. However, further inquiry by the Board is needed regarding whether Imhof wilfully failed to report certain conduct and whether, as a result of that inquiry, the discipline imposed should be modified.

ZALMA OPINION

The appellate court, dotting every “i” and crossing every “t” sent the case back to the Board to determine whether the failure to prove that Imhof intentionally failed to report his crimes to the Board, and whether that had any effect on the punishment. The criminal conduct should have been sufficient so, I expect, the Board will reconsider and then suspend the license.

© 2022 – Barry Zalma

Barry Zalma, Esq., CFE, now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders.

He practiced law in California for more than 44 years as an insurance coverage and claims handling lawyer and more than 54 years in the insurance business.

Subscribe to “Zalma on Insurance” at https://zalmaoninsurance.locals.com/subscribe and “Excellence in Claims Handling” at https://barryzalma.substack.com/welcome.

You can contact Mr. Zalma at https://www.zalma.com, https://www.claimschool.com, [email protected] and [email protected]. Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE Legend Award.

You may find interesting the podcast “Zalma On Insurance” at https://anchor.fm/barry-zalma;  you can follow Mr. Zalma on Twitter at; you should  see Barry Zalma’s videos on https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg/featured; or videos on https://rumble.com/zalma. Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims–library/ The last two issues of ZIFL are available at https://zalma.com/zalmas-insurance-fraud-letter-2/ 

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Solomon Like Decision: No Duty to Defend – Potential Duty to Indemnify

Concurrent Cause Doctrine Does Not Apply When all Causes are Excluded
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Death by Drug Overdose is Excluded

See the full video at https://lnkd.in/geQtybUJ and at https://lnkd.in/g_WNfMCZ, and at https://zalma.com/blog plus more than 5100 posts.

Southern Insurance Company Of Virginia v. Justin D. Mitchell, et al., No. 3:24-cv-00198, United States District Court, M.D. Tennessee, Nashville Division (October 10, 2024) Southern Insurance Company of Virginia sought a declaratory judgment regarding its duty to defend William Mitchell in a wrongful death case pending in California state court.

KEY POINTS

1. Motion for Judgment on the Pleadings: The Plaintiff moved for judgment on the pleadings, which was granted in part and denied in part.
2. Duty to Defend: The court found that the Plaintiff has no duty to defend William Mitchell in the California case due to a specific exclusion in the insurance policy.
3. Duty to Indemnify: The court could not determine at this stage whether the Plaintiff had a duty to ...

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July 17, 2025
No Good Deed Goes Unpunished

GEICO Sued Fraudulent Health Care Providers Under RICO and Settled with the Defendants Who Failed to Pay Settlement

See the full video at https://lnkd.in/gDpGzdR9 and at https://lnkd.in/gbDfikRG, and at https://zalma.com/blog plus more than 5100 posts.

Post 5119

Default of Settlement Agreement Reduced to Judgment

In Government Employees Insurance Company, Geico Indemnity Company, Geico General Insurance Company, and Geico Casualty Company v. Dominic Emeka Onyema, M.D., DEO Medical Services, P.C., and Healthwise Medical Associates, P.C., No. 24-CV-5287 (PKC) (JAM), United States District Court, E.D. New York (July 9, 2025)

Plaintiffs Government Employees Insurance Company and other GEICO companies (“GEICO”) sued Defendants Dominic Emeka Onyema, M.D. (“Onyema”), et al (collectively, “Defendants”) alleging breach of a settlement agreement entered into by the parties to resolve a previous, fraud-related lawsuit (the “Settlement Agreement”). GEICO moved the court for default judgment against ...

00:07:38
July 15, 2025
Zalma’s Insurance Fraud Letter – July 15, 2025

ZIFL – Volume 29, Issue 14
Post 5118

See the full video at https://lnkd.in/geddcnHj and at https://lnkd.in/g_rB9_th, and at https://zalma.com/blog plus more than 5100 posts.

You can read the full 20 page issue of the July 15, 2025 issue at https://lnkd.in/giaSdH29

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL

This issue contains the following articles about insurance fraud:

The Historical Basis of Punitive Damages

It is axiomatic that when a claim is denied for fraud that the fraudster will sue for breach of contract and the tort of bad faith and seek punitive damages.

The award of punitive-type damages was common in early legal systems and was mentioned in religious law as early as the Book of Exodus. Punitive-type damages were provided for in Babylonian law nearly 4000 years ago in the Code of Hammurabi.

You can read this article and the full 20 page issue of the July 15, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/07/ZIFL-07-15-2025.pdf

Insurer Refuses to Submit to No Fault Insurance Fraud

...

00:08:27
July 16, 2025
There is no Tort of Negligent Claims handling in Alaska

Rulings on Motions Reduced the Issues to be Presented at Trial

Read the full article at https://lnkd.in/gwJKZnCP and at https://zalma/blog plus more than 5100 posts.

CASE OVERVIEW

In Richard Bernier v. State Farm Mutual Automobile Insurance Company, No. 4:24-cv-00002-GMS, USDC, D. Alaska (May 28, 2025) Richard Bernier made claim under the underinsured motorist (UIM) coverage provided in his State Farm policy, was not satisfied with State Farm's offer and sued. Both parties tried to win by filing motions for summary judgment.

FACTS

Bernier was involved in an auto accident on November 18, 2020, and sought the maximum available UIM coverage under his policy, which was $50,000. State Farm initially offered him $31,342.36, which did not include prejudgment interest or attorney fees.

Prior to trial Bernier had three remaining claims against State Farm:

1. negligent and reckless claims handling;
2. violation of covenant of good faith and fair dealing; and
3. award of punitive damages.

Both Bernier and State Farm dispositive motions before ...

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May 15, 2025
Zalma's Insurance Fraud Letter - May 15, 2025

ZIFL Volume 29, Issue 10
The Source for the Insurance Fraud Professional

See the full video at https://lnkd.in/gK_P4-BK and at https://lnkd.in/g2Q7BHBu, and at https://zalma.com/blog and at https://lnkd.in/gjyMWHff.

Zalma’s Insurance Fraud Letter (ZIFL) continues its 29th year of publication dedicated to those involved in reducing the effect of insurance fraud. ZIFL is published 24 times a year by ClaimSchool and is written by Barry Zalma. It is provided FREE to anyone who visits the site at http://zalma.com/zalmas-insurance-fraud-letter-2/ You can read the full issue of the May 15, 2025 issue at http://zalma.com/blog/wp-content/uploads/2025/05/ZIFL-05-15-2025.pdf
This issue contains the following articles about insurance fraud:

Health Care Fraud Trial Results in Murder for Hire of Witness

To Avoid Conviction for Insurance Fraud Defendants Murder Witness

In United States of America v. Louis Age, Jr.; Stanton Guillory; Louis Age, III; Ronald Wilson, Jr., No. 22-30656, United States Court of Appeals, Fifth Circuit (April 25, 2025) the Fifth Circuit dealt with the ...

May 15, 2025
CGL Is Not a Medical Malpractice Policy

Professional Health Care Services Exclusion Effective

Post 5073

See the full video at https://lnkd.in/g-f6Tjm5 and at https://lnkd.in/gx3agRzi, and at https://zalma.com/blog plus more than 5050 posts.

This opinion is the recommendation of a Magistrate Judge to the District Court Judge and involves Travelers Casualty Insurance Company and its duty to defend the New Mexico Bone and Joint Institute (NMBJI) and its physicians in a medical negligence lawsuit brought by Tervon Dorsey.

In Travelers Casualty Insurance Company Of America v. New Mexico Bone And Joint Institute, P.C.; American Foundation Of Lower Extremity Surgery And Research, Inc., a New Mexico Corporation; Riley Rampton, DPM; Loren K. Spencer, DPM; Tervon Dorsey, individually; Kimberly Dorsey, individually; and Kate Ferlic as Guardian Ad Litem for K.D. and J.D., minors, No. 2:24-cv-0027 MV/DLM, United States District Court, D. New Mexico (May 8, 2025) the Magistrate Judge Recommended:

Insurance Coverage Dispute:

Travelers issued a Commercial General Liability ...

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