ZIFL Volume 27 Number 5
Barry Zalma
Read the full article at https://lnkd.in/gXiVeBE2 and see the full video at https://lnkd.in/gdTK4Qmu and at https://lnkd.in/gEhvKF4p, and read the full 22 page ZIFL in pdf format at https://lnkd.in/gzErgazV and at https://zalma.com/blog plus more than 4450 posts.
McClenny Moseley & Associates & Insurance Fraud
The McClenny Moseley & Associates (MMA) series of lawsuits, court hearings and insurance department actions have brought about some very serious problems for MMA, including court orders, lawsuit dismissals, administrative cease and desist orders and litigation, all of which have created a poster child for Zalma’s Insurance Fraud Letter.
Since MMA has admitted that it reported a claim to various insurers, including Allied Insurance, that it was presenting claims against Allied and at least 856 claims to Allied and other insurers, that it represented the insured when, in truth and fact, it did not represent the insurer’s insureds, but, rather Apex Roofing who is not an insured of any of the insurers to whom MMA made claims, demanded appraisal and settled claims, cashed checks and took attorneys fees from people it did not represent the insurer is obligated to report each claim to the Louisiana Department of Insurance as a suspected insurance fraud effected or attempted.
Therefore, it appears, subject to the review of the Louisiana Attorney General and/or local prosecutors, MMA violated Louisiana fraud statutes, and each insurer who is a victim of one or more of the minimum of 856 fraudulent claims where MMA represented it was the attorney of the insurers’ insureds was a criminal fraudulent act.
Since the actions of Velawcity and Apex Roofing appear to meet the definition of a “runner” the prosecutors in the state of Louisiana should consider prosecution for their fraudulent activities.
In addition, the federal judges involved in these cases should consider reporting MMA, Velawcity and Apex Roofing to the U.S. Attorney for investigation of the potential crime of wire fraud.
There will be more hearings in March 2023 that will be reported in the March 15, 2023 issue of ZIFL.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
The Arson for Profit Defense
To prove the “arson for profit defense” the insurer must prove the three elements needed to establish arson plus proof that the insured violated the misrepresentation, concealment, or fraud condition, and/or that the act was an intentional act to defraud the insurer.
A successful “arson for profit defense” depends on a wide range of evidence, including expert testimony, knowledgeable and convincing witnesses, and effective counsel for the insurer. Where any of the evidence as to each element is non-existent, weak, or sufficiently rebutted by the insured’s experts and witnesses, the insurer’s “arson for profit defense” will likely fail.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Good News from the Coalition Against Insurance Fraud
A firm that administered health care claims stole $18M of funds intended for paying the claims. Anthony Riccardi started by administering third-party healthcare claims for a car dealership chain in New Canaan, Conn. Employee Benefit Solutions created invoices for the car dealership brand, which submitted payments and expected the funds to be paid to health care providers. EBS stole almost $18M of $26M the dealership paid. Most of this money was transferred into the EBS operating account and used for non-company expenses — mortgages, boats, golf and luxury cars. Riccardi only paid claims from health care providers he thought were likely to complain, or involved the car dealership execs. The scam also included inflated or bogus medical claims, including some by a phony company under Riccardi’s name. Unpaid financial obligations began to mount, prompting Riccardi to apply for millions in fraudulent bank loans and cash advances. They were used in part to pay financial obligations to the car dealership brand. To cover up the loan scheme, Riccardi forged invoices from a fake company that supposedly sold upgraded billing software to EBS. Ricardi pled federally guilty. He faces up to 30 years in prison when sentenced and agreed to repay $14.8M.
Read the full article plus many more reports of convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
How to Add to the Professionalism of Insurance Claims Professionals
Every insurer, insurance syndicate, insurance brokerage, insurance sales agency, insurer branch office, and vendors to the insurance industry should add to the libraries of their various offices or employees.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Health Insurance Fraud Convictions
Ronald A. Beasley II, 33, of Portsmouth, Florida was the pharmacist in charge at NH Pharma, a pharmacy located in Lake Mary, Florida. Through NH Pharma, Beasley and his co-conspirators billed Medicare for expensive compound drug creams that they never
actually purchased or dispensed, and instead provided Medicare patients an inexpensive compound drug cream not covered by Medicare.
Inventory records showed that NH Pharma did not buy enough of the expensive prescription drugs to fill all the prescriptions NH Pharma billed to Medicare. In total, Beasley and his co-conspirators received more than $1 million in fraudulent proceeds from Medicare.
A federal jury in the Middle District of Florida convicted Beasley, a Virginia man February 9, 2023 for his role in a scheme to defraud Medicare of over $1 million in prescription drug benefits.
Beasley was convicted of conspiracy to commit health care fraud and three counts of health care fraud. He is scheduled to be sentenced on April 25 and faces a maximum penalty of 10 years in prison on each count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Read the full article including more than a dozen convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
The Brothers Ben-Cohain
The story that follows is a fictionalized True Crime Story of Insurance Fraud from my 55 Years in Insurance that explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. This is one of more than 80 stories in my book “Insurance Fraud Costs Everyone“ Available as a Kindle Book and Available as a Paperback from Amazon.com.
In 1990 Moshe Ben-Cohain and Menashe Ben-Cohain started a course of conduct that led to their arrest for insurance fraud. They failed to appear after posting bond and are, along with their co-conspirator, Raz Rosenberg, fugitives.
Read the full article and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
Other Insurance Fraud Convictions
Herbert Allen, age 38, and Dion Ridley, age 23, pleaded guilty to Conspiracy to Commit Mail Fraud in violation of Title 18, United States Code, Section 371 Allen was to 37 months in prison, followed by 3 years of supervised release and Ridley was sentenced to 6 months in prison, followed by 1 year of supervised release.
The defendants admitted to being in a conspiracy to commit mail fraud in connection with a staged automobile collision. In the scheme, Allen falsely claimed that he was the driver of a car that was struck by a tractor-trailer on June 28, 2017. Ridley, a passenger in the car, falsely claimed that Allen was driving the car and they were struck by a tractor-trailer.
In fact, the government’s evidence showed that the defendants conspired with Damien Labeaud, Roderick Hickman, and others to intentionally collide Allen’s 2007 Chevrolet Impala with a tractor-trailer in the area of Tchoupitoulas Street and Calliope Street in New Orleans.
Read the full article and about many more insurance fraud convictions and the full ZIFL at http://zalma.com/blog/wp-content/uploads/2023/02/ZIFL-03-01-2023.pdf.
(c) 2023 Barry Zalma & ClaimSchool, Inc.
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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]
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
Subscribe and receive videos limited to subscribers of Excellence in Claims Handling at locals.com https://lnkd.in/gfFKUaTf.
Go to substack at https://lnkd.in/gEEnV7Dd Consider subscribing to my publications at substack at https://lnkd.in/gEEnV7Dd
Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected]
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://lnkd.in/gWVSBde
Courts Must Never Speculate About Facts Not in Evidence
Post 5192
See the full video at https://rumble.com/v6z2r2s-duty-to-defend-is-not-without-limit.html and at https://youtu.be/3hhYFmKmGmA, and at https://zalma.com/blog plus more than 5,150 posts.
Injuries to Others at McDonald’s Do Not Provide Duty to Defend Suit by Employee Who Did Not Incur Bodily Injury
in McdDonald’s Corporation, et al v. Homeland Insurance Company Of New York, No. 23 C 16297, United States District Court, N.D. Illinois, Eastern Division (September 10, 2025) McDonald’s Corporation and McDonald’s USA LLC (collectively, “McDonald’s”) sued Defendant Homeland Insurance Company of New York (“Homeland”) challenging Homeland’s denial of coverage under a commercial general liability insurance policy.
BACKGROUND
A McDonald’s franchisee operated the McDonald’s restaurant (“Restaurant”) located in Chicago, Illinois. (hereinafter, “PRSOF”). From March 1, 2015 through March 1, 2018, the franchisee maintained a ...
Breach of Material Condition for Monitored Fire Alarm Voids Coverage
See the full video at https://rumble.com/v6z0zh4-there-is-no-excuse-for-lying-to-an-insurer.html and at https://youtu.be/6PhLIpzBnQw, and at https://zalma.com/blog plus more than 5150 posts.
No Monitored Fire Alarm: No Coverage
Post 5191
In Northfield Insurance Co. v. Michigan 32, LLC, No. 24-CV-12822, United States District Court, E.D. Michigan, Southern Division (September 10, 2025) Defendant Michigan 32, LLC’s (MI 32) moved the court for reconsideration of the Court’s Opinion and Order granting summary judgment to Plaintiff Northfield Insurance Company (Northfield).
The matter arose out of a commercial insurance coverage dispute wherein Northfield denied MI 32’s fire loss claim. The Court granted summary judgment in favor of Northfield on its Declaratory Judgment action.
THE ORIGINAL DECISION
The Protective Safeguard Endorsement
The Court held that MI 32’s admitted failure to comply with its Policy’s Protective Safeguard Endorsement...
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Post 5190
ZIFL Volume 29, Issue 18
See the full video at https://rumble.com/v6yuis6-zalmas-insurance-fraud-letter-september-15-2025.html and at https://youtu.be/64CobaRmzd0, at https://zalma.com/blog, and https://zalma.com/blog/wp-content/uploads/2025/08/ZIFL-09-01-2025-1.pdf.
Posted on September 15, 2025 by Barry Zalma
ZIFL Volume 29, Issue 18
THE SOURCE FOR THE INSURANCE FRAUD PROFESSIONAL
Subscribe to the e-mail Version of ZIFL, it’s Free!
Post 5190
See the full video at https://rumble.com/v6yuis6-zalmas-insurance-fraud-letter-september-15-2025.html and at https://youtu.be/64CobaRmzd0
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/
The Contents of the September 15, 2025 Issue of ZIFL Includes:
...
How a Need for Profit Led Health Care Providers to Crime
Post 5185
Posted on September 8, 2025 by Barry Zalma
See the full video at https://lnkd.in/gePN7rjm and at https://lnkd.in/gzPwr-9q
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.
The Dishonest Chiropractor/Physician
How a Need for Profit Led Health Care Providers to Crime
See the full video at and at
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.
How Elderly Doctors Fund their ...
How a Need for Profit Led Health Care Providers to Crime
Post 5185
Posted on September 8, 2025 by Barry Zalma
See the full video at https://lnkd.in/gePN7rjm and at https://lnkd.in/gzPwr-9q
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers.
The Dishonest Chiropractor/Physician
How a Need for Profit Led Health Care Providers to Crime
See the full video at and at
This is a Fictionalized True Crime Story of Insurance Fraud from an Expert who explains why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is designed to help to Understand How Insurance Fraud in America is Costing Everyone who Buys Insurance Thousands of Dollars Every year and Why Insurance Fraud is Safer and More Profitable for the Perpetrators than any Other Crime.
How Elderly Doctors Fund their ...
Barry Zalma: Insurance Claims Expert Witness
Posted on September 3, 2025 by Barry Zalma
The Need for a Claims Handling Expert to Defend or Prove a Tort of Bad Faith Suit
© 2025 Barry Zalma, Esq., CFE
When I finished my three year enlistment in the US Army as a Special Agent of US Army Intelligence in 1967, I sought employment where I could use the investigative skills I learned in the Army. After some searching I was hired as a claims trainee by the Fireman’s Fund American Insurance Company. For five years, while attending law school at night while working full time as an insurance adjuster I became familiar with every aspect of the commercial insurance industry.
On January 2, 1972 I was admitted to the California Bar. I practiced law, specializing in insurance claims, insurance coverage and defense of claims against people insured and defense of insurance companies sued for breach of contract and breach of the implied covenant of good faith and fair dealing. After 45 years as an active lawyer, I asked that my license to practice law be declared inactive ...