Zalma’s Insurance Fraud Letter – February 15, 2024
Read the full article at https://lnkd.in/gWtgr8CU, see the full video at https://lnkd.in/gwMvCEr3 and at https://lnkd.in/ghc-d846, at https://zalma.com/blog & https://lnkd.in/gpHAQ-mz.
ZIFL Volume 28, Issue 4
Post 4735
The Source for the Insurance Fraud Professional
Zalma’s Insurance Fraud Letter (ZIFL) continues its 28th 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 https://lnkd.in/gVT5G9s
The current issue can be read in full at https://lnkd.in/gpHAQ-mz and includes the following articles:
Do the Crime, Serve the Time
After pleading guilty, Armando Valdes appealed his 60-month sentence for health care fraud.
Read the full article in Adobe pdf format at https://lnkd.in/gpHAQ-mz
More McClenny Moseley & Associates Issues
This is ZIFL’s twenty fourth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana.
Read the full article in Adobe pdf format at https://lnkd.in/gpHAQ-mz
California Insurance Commissioner Lara Issues Consumer Fraud Alert As Flood Recovery Begins In San Diego County.
Health Insurance Fraud Convictions
Guilty in Arkansas
Shaona Mizell, 52, of Paragould, Arkansas. in Pulaski County Circuit Court on January 23, Mizell pleaded guilty to Medicaid Fraud.
Arson and Restitution
CONVICTED ARSONIST MUST PAY RESTITUTION
In State Of Washington v. M.W., No. 85908-1-I, Court of Appeals of Washington, Division 1 (January 29, 2024) the court resolved the issue.
New Book Now Available from Barry Zalma
"Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition"
Available at the Insurance Claims Library – https://lnkd.in/gKCTg53
Other Insurance Fraud Convictions
Kentucky Farmer Pleads Guilty to Multi-Million Dollar Crop Insurance Fraud Scheme
David Manion, a farmer from Simpson County, Kentucky, has confessed to orchestrating a fraudulent scheme that defrauded the federal government’s crop insurance program out of millions of dollars.
Insurance Fraud Attempt Defeated
THE HAWAIIAN, ATTEMPTED FRAUD DEFEATED BY A THOROUGH INVESTIGATION
The following 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.
Read the full article in Adobe pdf format at https://lnkd.in/gpHAQ-mz
(c) 2024 Barry Zalma & ClaimSchool, Inc.
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Insurance Expert May Not Testify to Speculative and Contains Unsupported Conclusions.
Posted on September 18, 2026 by Barry Zalma
See the full video at and at https://rumble.com/v7fmifw-expert-may-only-testify-to-what-experience-supports.html
In Michele A. Over, and The Estate Of Paul R. Over v. State Farm Mutual Automobile Insurance Company, and State Farm Fire And Casualty Company, Civil Action No. 23-cv-02243-PAB-STV, United States District Court, D. Colorado (September 14, 2026) Michele and Paul Over sued State Farm Fire and State Farm Auto over hail-damage and stolen-vehicle claims.
The operative dispute concerned State Farm Auto’s motion to exclude or limit opinions from plaintiffs’ insurance-industry expert, Aaron Castillo. Castillo.
Law
The proponent of expert testimony must establish by a preponderance of the evidence that an expert is qualified and that the opinions are helpful, sufficiently grounded, and reliably derived and applied. Experience-based opinions must explain how the...
150 Months in Prison for Tax Fraud
Post 4846
Posted on September 17, 2026 by Barry Zalma
See the full video at https://lnkd.in/g8rh3JBX and https://lnkd.in/gmkdy-9C, In United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
In United States Of America v. Thomas Addaquay, United States Of America v. Thomas Addaquay, Nos. 25-10609, 25-10611, United States Court of Appeals, Eleventh Circuit (September 9, 2026) the Eleventh Circuit affirmed all challenged convictions, the 150-month aggregate sentence, and the challenged $4,123,474.55 restitution award.
FACTS
Thomas Addaquay controlled United Consolidated Accounting and Business Services (UC), nominally a check-cashing business.
The government proved a three-stage tax-refund scheme that converted the resulting refund checks into usable funds through ...
Major Fraud Perpetrator Asserts Fifth Amendment Privilege to Avoid Prosecution
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Posted on September 14, 2026 by Barry Zalma
Fraudster Refuses to Answer Questions About His Alleged Fraud
See the full video at https://lnkd.in/gvicAMDr and at https://lnkd.in/gvicAMDr
In Great American Insurance Co. v. Gemstone Property Management, LLC, et al., No. 23-cv-9100 (LJL), United States District Court, S.D. New York (September 8, 2026) Great American Insurance Company alleged that it was defrauded through a scheme in which Subin Associates, LLP recruited individuals to stage construction-site injuries, arranged unnecessary medical treatment and litigation funding, and pursued fraudulent personal-injury claims.
Luis Manuel Garcia Salcedo, resulted in a $6 million settlement. Non-party Jose Hernandez allegedly worked as an assistant manager at Subin, operated Hernandez Associates, and owned litigation-funding companies that shared office space with Subin and provided services to its clients.
After Great American ...
Excellence in Claims Handling
Posted on October 29, 2026 by Barry Zalma
Common Problems in a Jewelers’ Block Policy Investigation
If you are not a subscriber you will read from this link until you reach the paywall end of this blog post as the free part of Excellence in Claims Handling. You should consider joining as a paid member to get full access to articles for members only, to our news, analysis, insurance coverage, claims, insurance fraud and insurance webinars, by clicking at the button above.
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The History of the Jewelers’ Block Policy
The ‘jewelers’ block policy’ had its origin about 1920, and since that time the policy and the proposal upon which it is based have become more or less standard.
The Inland-Marine Insurance Bureau, of which appellant is a member, prescribes contracts and proposals for such policies that are ...
Self Insurance is Excess Over Primary Insurance
Post 4572
Posted on October 29, 2026 by Barry Zalma
Employment Plan is Insurance Because it Transferred Risk and Contained Claim, Exclusion, and Priority Provisions.
In Ajay Kolli, & c. et al. v. Kaleida Health, 2026 NY Slip Op 06167, No. 72, New York Court of Appeals (October 22, 2026) Dr. Venkateswara Kolli treated a patient in 2011 while serving as an on-call, per diem physician for Kaleida Health. The patient later sued Dr. Kolli and Kaleida for medical malpractice.
In 2011, decedent Dr. Venkateswara Kolli treated a patient as part of his duties pursuant to an on-call, per diem physician employment agreement with defendant Kaleida Health. The patient subsequently sued Dr. Kolli and Kaleida. Dr. Kolli sought indemnity from his primary medical malpractice insurer, MLMIC Insurance Company (MLMIC), as well as his excess insurer Healthcare Professionals Insurance Company (HPIC).
The underlying medical malpractice action settled after Dr. Kolli’s death. Kaleida, MLMIC, and ...
RICO Suit Against Law Firm & Health Care Pros Fails
Posted on October 28, 2026 by Barry Zalma
UBER AND FEDEX FIGHT FRAUD
Racketeer Influenced and Corrupt Organizations Act (RICO) is Designed to Defeat Fraud Perpetrators
In Uber Technologies, Inc., et al. v. Simon & Simon P.C., et al., Civil Action No. 25-5365, United States District Court, E.D. Pennsylvania (October 13, 2026) Uber Technologies, Inc. and Federal Express Corporation sued attorney Marc Simon, his firm Simon & Simon, P.C., and several medical professionals and practices under the Racketeer Influenced and Corrupt Organizations Act (RICO).
They allege the defendants orchestrated a scheme to generate and litigate fraudulent personal injury claims arising from motor vehicle accidents involving Uber and FedEx drivers. Uber and FedEx incurred defense costs and paid settlements on some claims. The court earlier denied a motion to dismiss, finding proximate causation adequately pleaded. Fact discovery is set to close December 21, 2026.
Discovery showed Uber’s...
