Zalma’s Insurance Fraud Letter – July 1, 2022
ZIFL 7-1-2022
Read the full article at https://lnkd.in/gkTM34Qb, see the video explaining what is in the July 1, 2022 issue at https://lnkd.in/gi2jdegx and at https://lnkd.in/gb2hxnF9 and at https://zalma.com/blog plus more than 4250 posts.
ZIFL Volume 26 Number 13
ZIFL-07-01-2022 http://zalma.com/blog/wp-content/uploads/2022/06/ZIFL-07-01-2022.-1.pdf.
See the video explaining what is in the July 1, 2022 issue at https://rumble.com/v1al2t7-zalmas-insurance-fraud-letter-july-1-2022.html?mref=6zof&mrefc=3 and at
In the July 1, 2022 issue of Zalma’s Insurance Fraud Letter you will be able to read the full text of articles including:
Bases for Rescission
Rescission Is an Equitable Remedy First Created in The Ecclesiastical Courts of Elizabethan England.
When the United States was conceived in 1776 the founders were concerned with protecting their rights under British common law.
Common Law is a form of law developed by judges through tribunals and decisions of courts rather than executive branch action and legislative statutes.
Following the common law tradition, legal principles were referred to courts of equity to “mitigate the rigor” of the common law.
The new United States of America adopted British common law as the law once the U.S. Constitution was adopted in 1789. British common law was only modified by the limitations placed on the central government by the Constitution.
The viability and ability to enforce contracts was recognized as essential to commerce. Courts of law, following the British Common Law, were charged with enforcing legitimate contracts and rendering money judgments against the party who breached the contract.
Another Florida Insurer Goes Broke
Southern Fidelity Insurance Company has entered into receivership and is being liquidated, according to the Florida Office of Insurance Regulations (FLOIR).
Insurance fraud is rampant in Florida.
Lawyer Admits to Insurance Fraud & Theft from Clients
Convicted of Fraud & Theft Enough for Disbarment
On September 7, 2021, the Office of Disciplinary Counsel (ODC) requested this Court place Respondent Richard Alexander Murdaugh on interim suspension based upon information indicating Respondent had stolen funds from the law firm that employed him. Respondent consented to the relief and on September 8, 2021, the Supreme Court issued an order suspending Respondent from the practice of law. In re Murdaugh, 434 S.C. 233, 863 S.E.2d 335 (2021) and, in In the Matter of Richard Alexander Murdaugh, Supreme Court of South Carolina, June 16, 2022 the Supreme Court was faced with the obligation to render a final order re Murdaugh’s license to practice law.
Chutzpah: Murder for Insurance Money Life Sentences Affirmed
INSURANCE FRAUD IS A VIOLENT CRIME
When convicted of murder in the first degree and conspiracy to commit murder for life insurance money, the defendants require a great deal of chutzpah (unmitigated gall) to file multiple appeals to reduce or eliminate the life without parole sentences. In the latest effort, The People v. Leny Peterson Galafate, F081563, California Court of Appeals, Fifth District (June 9, 2022) the Court of Appeal wrote a detailed opinion discussing all of the arguments filed by the murderer expending more time and paper than a convicted murder who had already appealed unsuccessfully to different courts that was not deserved.
Good News From the Coalition Against Insurance Fraud
Health Insurance Fraud Convictions
Molina Healthcare Agrees to Pay Over $4.5 Million To Resolve False Claims Act Violations
Molina Healthcare, Inc. (Molina) and its previously owned subsidiary, Pathways of Massachusetts (Pathways), have agreed to pay $4.625 million to resolve allegations that it violated the False Claims Act by submitting reimbursement claims while violating several regulations related to the licensure and supervision of staff.
Molina is a managed care health services company that provides health care plans to various state and federal health care programs including MassHealth, the joint federal and state Medicaid program. Between November 2015 and March 2018, Molina owned and operated Pathways, a group of mental health centers located in Springfield and Worcester. During that period, the government contends that Molina and Pathways improperly submitted claims for reimbursement to MassHealth and care entities managed by MassHealth while failing to properly license and supervise mental health center staff, including social workers and psychological associates, and failing to provide and timely document the provision of adequate clinical supervision to clinicians requiring supervision.
Excellence in Claims Handling
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Become a Professional Claims Handler
In search of profit, insurers have decimated their professional claims staff. They laid off experienced personnel and replaced them with young, untrained, unprepared people. A virtual clerk replaced the old professional claims handler. Process and computers replaced hands-on human skill, empathy and judgment. Money was saved by paying lower salaries. Within three months of firing the experienced claims people gross profit increased.
Other Insurance Fraud Convictions
Ex-Surrey Banker Faked Cancer as Part Of £1.8m Fraud
Rajesh Ghedia, 42, said he would be dead in a year in a £1.2m insurance scam, Southwark Crown Court heard. He also swindled seven people – including a relative – out of huge sums of money by encouraging them to invest in non-existent financial products.
(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].
Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe.
Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome.
See the last two issues of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/
Write to Mr. Zalma at [email protected]; http://www.zalma.com; http://zalma.com/blog; daily articles are published at https://zalma.substack.com.
Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma; Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Proof of Highly Contaminated Water is Required for Extra Payments
Post number 5300
Read the full article at https://www.linkedin.com/pulse/acting-your-own-lawyer-foolish-barry-zalma-esq-cfe-mbg0c, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Acting as Your Own Lawyer is Foolish
Evidence of Breach of Contract Survives Dismissal of All Other Charges
In Lee Lifeng Hsu and Jane Yuchen Hsu v. State Farm Fire And Casualty Company, C. A. No. N24C-09-020 CLS, Superior Court of Delaware (February 27, 2026) a claim to State Farm who paid approximately $61,000 after assessments but denied coverage for additional items including ceramic tiles, the kitchen floor ceiling, underlayment plywood, and numerous personal property items resulted in suit by the Hsu’s acting in pro per.
Facts
Lee Lifeng Hsu and Jane Yuchen Hsu (“Plaintiffs”) purchased a homeowners’ insurance policy from State Farm Fire...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
