ZIFL Volume 27, Issue 21
Barry Zalma
Nov 1, 2023
Read the full article at https://lnkd.in/gxkV6rMt and see the full video at https://lnkd.in/gcze7hvA and at https://lnkd.in/g9yDwegV and at https://zalma.com/blog and https://lnkd.in/gzC4jCvG.
The Resource for the Insurance Claims and Insurance Fraud Professionals
What a Great Country!
"This article 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 posted 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 Insurance Fraud Can Succeed
Wo Ping Chen was trained as a physician in Hong Kong. Until Hong Kong was returned by the United Kingdom to the Peoples Republic of China, he was the best-known Orthopedist in the Crown Colony. Fearing problems with the new government he emigrated to Vancouver, British Columbia, Canada as a citizen of the commonwealth.
He worked as an employee of the National Health Service for a year and then obtained a work visa to the U.S. and crossed the border into the U.S. only to find he could not work as a physician without a license from a U.S. state and attended a U.S. based medical school. After one year of medical school, one year of internship in a Seattle hospital and one year as a resident Chen was able to restart his life.
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More McClenny Moseley & Associates Issues
This is ZIFL’s seventeenth 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 indicate may be criminal conduct to profit from insurance claims relating to hurricane damage to the public of the state of Louisiana.
Access Restoration Services U.S., Inc. and MMA Scheme Alleged in Detailed New Orleans Court Pleading and more.
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After Avoiding Prison Fraudster Appeals Unsuccessfully
False Lightning Strike Claim Results in Fraud Conviction
Sara Weisbeck appealed her convictions for insurance fraud: false material information and identity theft over $1500 and under $10,000, both class “D” felonies. In State of Iowa v. Sara Jo Weisbeck, No. 22-1068, Court of Appeals of Iowa (October 11, 2023) considered her pleas for mercy.
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Health Insurance Fraud Convictions
Tampa Pain Management Physician Edward Lubin Agrees to Pay $1.5 Million To Settle False Claims Act Liability for Receiving Bribes and Writing Unnecessary Fentanyl Prescriptions
Edward Lubin, a pain management physician agreed to pay the United States $1.5 million to resolve allegations that he violated the False Claims Act (FCA) by causing the submission of claims for fentanyl prescriptions that were written in exchange for kickback payments and that were medically unnecessary. The agreement resolves the United States’ claims against Dr. Lubin under the FCA. The claims resolved by the settlement are allegations only, and there has been no admission or determination of liability.
Read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/gzC4jCvGand at http://zalma.com/.../uploads/2023/10/ZIFL-11-01-2023.pdf
Other Insurance Fraud Convictions
Claims Adjuster Will Serve Prison Time for Fraud Scheme
Paul Richard Massey, of Shady Spring, West Virginia, a former Allstate claims adjuster, will spend one year and a day in prison, forfeit his beach house and pickup truck to the federal government after pleading guilty to wire fraud and money laundering.
Federal prosecutors alleged that 51-year-old Massey issued 68 fraudulent checks from Allstate accounts totaling $862,871.29 while he worked as a claims adjuster in 2018 and 2019. Massey had settlement authority for up to $100,000 in his position with Allstate.
Read this article, and dozens convictions and the full 20 pages of this issue at ZIFL in pdf and read this article and the full 20 pages of this issue at ZIFL in pdf at https://lnkd.in/gzC4jCvG.
Crime Does Not Allow Insurer to Pay
Withholding Coverage for Criminal Acts Disincentivizes Criminal Conduct
Safeway Insurance Company sought supervisory writs from the judgment of the lower court which denied its motion for summary judgment. In Damien Harris v. Safeway Insurance Company Of Louisiana And Justin Rossette, No. CW 23-165, Court of Appeals of Louisiana, Third Circuit (October 25, 2023) the Louisiana Court of Appeals resolved an insurance coverage dispute over a criminal acts exclusion.
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(c) 2023 Barry Zalma & ClaimSchool, Inc.
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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 ...
