Zalma on Insurance
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Insurance Claims professional presents articles and videos on insurance, insurance Claims and insurance law for insurance Claims adjusters, insurance professionals and insurance lawyers who wish to improve their skills and knowledge. Presented by an internationally recognized expert and author.
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May 10, 2022
True Crime of Insurance Fraud Video Number 70

The Golden Taxi
Read the full article at https://lnkd.in/gpaJhkkZ and see the full video at https://lnkd.in/g5wDZPpn and at https://lnkd.in/g_ZWpmc4 and at https://zalma.com/blog plus more than 4200 posts.

Mischa came to Houston in 1990 directly from the old Soviet Union. His dream was to be a cowboy. He became a cab driver.

Mischa picked up the English language quickly and memorized the convoluted streets of Houston. Within a year of his arrival, he could find with ease any hotel, restaurant or bar in the overgrown small town that was Houston, Texas.

Mischa made a reasonable living driving a cab, making the forty-five-minute run in from the airport at least three times a day. He bought a small three bedroom house outside Houston and was building his way toward the American dream. Mischa was not a criminal. He drove his cab twelve hours a day, six days a week to support himself and his young wife.

Mischa’s life changed when the dispatcher called him to the home of Sophie Mendelson. Sophie, an eighty-year-old Medicare patient, needed a ride to her doctor’s office, four miles from her home.

Upon arrival at the doctor’s office Sophie gave Mischa the information necessary to bill Medicare direct for his services. He complied and within weeks received a check from the US Treasury. It seemed all that Medicare required before it sent a check was information concerning the patient, a Medicare number, and whatever he wanted for the miles driven. Mischa satisfied Medicare if the fare reasonably related to the amount of miles he claimed.

Mischa was an intelligent man. He grew up in the Soviet Union, so he had no respect for government. In fact, as a child and as an adult living in the Soviet Union, he learned that the only way to survive was to deceive the ever-present government.

He was surprised to learn how unlike the Soviet government was the U.S. government. Rather than expecting deceit from its citizens, the U.S. government seemed to believe everything told to it by its residents.

The ride he gave Sophie Mendelson gave Mischa a plan to obtain a fortune. Mischa advised his dispatcher that he would volunteer to take all the Medicare, Medicaid, and welfare patient rides called into his cab. Since the other drivers did not like to wait for the payments from the government, Mischa received all of the calls. Within a month he had created a ledger containing 100 names, addresses and Medicare numbers.

With a calculator, a tax rate table and a pad of receipts, Mischa started on his journey to earn his first million dollars. He created receipts for five doctor visits for every one he actually drove. Mischa extended the distance to each doctor by a factor of three. In his first year he collected more than a million dollars from the United States, state and county governments. The next year his collections (since his number of welfare and Medicare recipients had increased in his ledger) had gone to two million dollars.

Mischa sold his three bedroom house and bought a 500-acre ranch with a four thousand square foot, six bedroom ranch house and stables. He began to live his dream of being a cowboy. Mischa bought 500 head of long horn steers and three quarter horses.

Mischa, the Russian cowboy, continued his profitable taxi business for three more years. An auditor for the State of Texas, Department of Social Services first noticed that Mischa’s cab company had taken a client to the doctor who had died a month before the trip.

The auditor then found each receipt submitted by Mischa to the State of Texas and Harris County. When he was done, the auditor found that in 1994, if the records were accurate, Mischa had driven the 1992 Chevrolet Caprice taxi cab a total of 1,250,000 miles.

The auditor concluded Mischa needed to drive more than 3,000 miles a day, sixteen hours a day, 365 days a year at more than 200 miles an hour to justify his claims. Belatedly, the government caught on to Mischa’s fraud.

The Texas Attorney General arrested, tried and convicted Mischa of defrauding the State of Texas and Harris County Texas. The Judge ordered that he pay a fine of $50,000 and to serve ninety days in jail. Because he was a first offender, Mischa was placed on probation for five years.

Mischa continues to live his dream as a cowboy, breeding Texas long horn cattle on his ranch outside Houston. The United States government, although advised of the crime by Harris County officials, refused to prosecute since the fraud would seriously embarrass the Medicare system.

Everyone involved, especially Mischa, believed that justice had been served.
ZALMA OPINION

When a person is convicted of insurance fraud there is no deterrence shown if the only punishment is to allow the criminal to be placed on probation and allow him or her to keep the fruits of the crime. Justice should never include allowing someone like Mischa to profit from the crime.
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(c) 2022 Barry Zalma & ClaimSchool, Inc.

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. He is available at http://www.zalma.com and [email protected].

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Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com.

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20 hours ago
Zalma’s Insurance Fraud Letter – November 1, 2025

ZIFL – Volume 29, Issue 21

THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL

Post 5220

Read the full article at https://lnkd.in/gRMJpi4s, see the video at https://lnkd.in/gwGSd6ZA & at https://lnkd.in/gbDiuFJy, and at https://zalma.com/blog plus more than 5200 posts.

See the video at & at https://rumble.com/v711hr0-zalmas-insurance-fraud-letter-november-1-2025.html

See the full 18 page issue of ZIFL at ZIFL-11-01-2025

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/

Conviction for Health Insurance Fraud Upheld

Physician Conspired with Bonavilla to Effect Health Insurance Fraud

Dennis Davin Bonavilla was involved in an insurance fraud scheme as an executive of Free Choice Healthcare. The scheme targeted indigent patients, often on ...

00:10:22
October 31, 2025
The Zalma Philosophy of Claims Handling – Part 8

The Professional Claims Handler

Post 5218

Read the full article at https://www.linkedin.com/pulse/zalma-philosophy-claims-handling-part-8-barry-zalma-esq-cfe-zdwsc, see the full video at https://rumble.com/v70zl4s-the-zalma-philosophy-of-claims-handling-part-8.html and at https://youtu.be/MIYcF71ffRQ, and at https://zalma.com/blog plus more than 5200 posts.

Claims Commandment X – Thou Shall Not Pretend to be a Lawyer

Some experienced and professional claims people know the law in their area of expertise better than most lawyers.

Adjusters should be adjusters and leave lawyering to lawyers. Similarly, lawyers should be lawyers and never try to be adjusters.

Claims Commandment XI – Thou Shall Empathize With the Claimant

Everyone presenting a claim is unhappy, disturbed, shocked, injured and needs help.

Empathy is identification with and understanding of another’s situation, feelings, and motives. It is the ability to understand another person’s circumstances, point of view, thoughts, and feelings....

00:11:08
October 28, 2025
The Zalma Philosophy of Claims Handling – Part 6

HOW TO CREATE AN EXCELLENCE IN CLAIMS HANDLING PROGRAM

See the full video at https://rumble.com/v70wb2i-the-zalma-philosophy-of-claims-handling-part-6.html and at https://youtu.be/tL5nDKPEs40 and at https://zalma.com/blog plus more than 5200 posts.

Post 5217

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry.

An Excellence in Claims Handling program begins with a statement in the insurer’s claims manual or statement of professionalism that it is dedicated to providing excellence in claims handling to every insured who presents a claim.

The excellence in claims handling program should include, at a minimum:

A series of lectures supported by text materials explaining:
A definition of insurance.
How to read and understand an insurance policy.
How to interview an insured, witness, or claimant.
How to assist an insured in the insured’s obligation to ...

00:08:40
October 31, 2025
The Zalma Philosophy of Claims Handling – Part 9

The Professional Claims Handler
Post 5219

Posted on October 31, 2025 by Barry Zalma

An Insurance claims professionals should be a person who:

Can read and understand the insurance policies issued by the insurer.
Understands the promises made by the policy.
Understand their obligation, as an insurer’s claims staff, to fulfill the promises made.
Are competent investigators.
Have empathy and recognize the difference between empathy and sympathy.
Understand medicine relating to traumatic injuries and are sufficiently versed in tort law to deal with lawyers as equals.
Understand how to repair damage to real and personal property and the value of the repairs or the property.
Understand how to negotiate a fair and reasonable settlement with the insured that is fair and reasonable to both the insured and the insurer.

How to Create Claims Professionals

To avoid fraudulent claims, claims of breach of contract, bad faith, punitive damages, unresolved losses, and to make a profit, insurers ...

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October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail
Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.
My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

post photo preview
October 20, 2025
The Zalma Philosophy of Claims Handling – Part I

The History Behind the Creation of a Claims Handling Expert

The Insurance Industry Needs to Implement Excellence in Claims Handling or Fail

Post 5210

This is a change from my normal blog postings. It is my attempt. in more than one post, to explain the need for professional claims representatives who comply with the basic custom and practice of the insurance industry. This statement of my philosophy on claims handling starts with my history as a claims adjuster, insurance defense and coverage lawyer and insurance claims handling expert.

My Training to be an Insurance Claims Adjuster

When I was discharged from the US Army in 1967 I was hired as an insurance adjuster trainee by a professional and well respected insurance company. The insurer took a chance on me because I had been an Army Intelligence Investigator for my three years in the military and could use that training and experience to be a basis to become a professional insurance adjuster.

I was initially sat at a desk reading a text-book on insurance ...

post photo preview
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