ZIFL Volume 28, Issue 5, March 1, 2024
Barry Zalma
Mar 1, 2024
Read the full article at https://lnkd.in/giAFKxg8; read a full .pdf copy of Zalma's Insurance Fraud Letter at https://lnkd.in/g6QKzNca, See the full video at https://lnkd.in/gjeZwjy9 and at https://lnkd.in/gjgQqUfQ, and at https://zalma.com/blog plus more than 4700 posts.
The Source for the Insurance Fraud Professional
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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 http://zalma.com/zalmas-insurance-fraud-letter-2/
The current issue can be read in full at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf and includes the following articles:
Bloods Gang Member Guilty of RICO to Defraud Insurers
Gangs Took Over Fire Reconstruction Industry in New York
Insurance Fraud is a Violent Crime
Jatiek Smith (also known as “Tiek”) a member of the Bloods Gang was charged with one count of racketeering conspiracy, in violation of 18 U.S.C. § 1962(d), and one count of extortion conspiracy, in violation of 18 U.S.C. § 1951, arising out of allegations that Smith and his co-conspirators engaged in a pattern of extortionate conduct to dominate the fire restoration industry. Smith’s case was tried in a ten-day bench trial between November 27, 2023, and December 11, 2023.
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
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 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.
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
A New Book: “Once Upon A Claim”
From my friend Chantel M. Roberts whose site lists all her books, and a new author, George Jack – from the Insurance Academy.
https://www.tiltingatwindmillspress.com/
and whose blog you can read at: https://www.tiltingatwindmillspress.com/.../unlocking... where she explains the illustrations.
Picture this: classic fairy tales, nursery rhymes, and fables brought to life with whimsical illustrations and sprinkled with valuable lessons about insurance concepts and claims processes. It may sound like a magical dream, but it’s a reality with the upcoming book, Once Upon A Claim: Fairy Tales to Protect Your Ass(ets).
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
Go To Jail, Do Not Pass Go, Stay in Jail
Insurance Agent Defrauded Clients by Keeping Premium for His Own Benefit
In United States Of America v. John M. Thomas, a.k.a. John Thomas, No. 23-11137, United States Court of Appeals, Eleventh Circuit (February 20, 2024) Thomas appealed from his 168-month sentence for 16 counts of wire fraud, 4 counts of money laundering, and 4 counts of money laundering to conceal proceeds of unlawful activity.
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
Barratry
Use of cappers or runners to sign up clients for lawyers is a form of barratry and a type of fraud. Barratry is a very dirty word in the legal profession. Barratry is the vexatious incitement to litigation, typically by soliciting potential legal clients. Stated otherwise, barratry occurs when a lawyer or someone acting on a lawyer’s behalf improperly solicits someone to be a plaintiff in a lawsuit. Think ambulance chasing.
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
From the Coalition Against Insurance Fraud
Enfield woman sentenced for larceny in Medicaid case. Marcy L. Taliceo, from Enfield, pleaded guilty this week in Hartford Superior Court to one count of Larceny related to Medicare fraud. Between 2016 and 2020, Taliceo was billing the state Medicaid program for services done by unlicensed personnel and services that were never provided. Taliceo was President, Treasurer and Secretary of Growing Potential Services, a Connecticut Medical Assistance Program (CMAP) provider that was enrolled as a Behavioral Health Clinician Group. Taliceo was in charge of all aspects of the business, including what services were billed. Growing Potential was paid by the Connecticut Medicaid Program for psychotherapy services by unlicensed individuals in the amount of almost $142K. In addition, Growing Potential was paid a total of nearly $7K for these services. Taliceo was sentenced to four years in prison, execution suspended, with five years of probation. In addition, restitution for the stolen amount must be paid back in full.
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
Health Insurance Fraud Convictions
Holy Health Care Services, LLC Program Administrator Sentenced to Five Years in Federal Prison for a Health Care Fraud
Lambert Mbom, age 50, of Riverdale, Maryland, was sentenced by U.S. District Judge Paula Xinis to five years in federal prison, followed by three years of supervised release, for conspiracy to commit health care fraud and wire fraud and for conspiracy to make false statements relating to health care matters in connection with a scheme to fraudulently bill Medicaid. The defendant’s conviction stems from a scheme involving services purportedly provided by Holy Health Care Services, LLC (“Holy Health”), a mental health services provider with locations in Washington, D.C. Judge Xinis also ordered Mbom to pay restitution in the full amount of the loss, $4,450,588.66. The sentence was imposed on February 8, 2024.
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
New Book Now Available from Barry Zalma
“Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition”
Property Investigation Checklists: Uncovering Insurance Fraud, 14th Edition provides detailed guidance and practical information on the four primary areas of any investigation of suspicious claims. The book also examines recent developments in areas such as arson investigation procedures, bad faith, extracontractual damages, The fake burglary, and Lawyers Deceiving Insurers, Courts & Their Clients During, Catastrophes—A New Type Of Fraud and the appendices includes the NAIC Insurance Information and Privacy Protection Model Act and usable forms for everyone involved in claims and will provide necessary information to the claims adjuster, SIU fraud investigator, claims manager, or coverage lawyer so he or she can be capable of excellence.
The newest book joins other insurance, insurance claims, insurance fraud, and insurance law books by Barry Zalma all available at the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/
Other Insurance Fraud Convictions
Illinois Insurance Agent Sentenced to 7 Years in Prison for Swindling Premiums
Daniel M. Rosenbaum owned and operated Alexander & Rosenbaum Financial Group LLC, an insurance agency in Kenilworth, Ill. Beginning in 2016, Rosenbaum collected more than $1 million in annuity premiums from at least 18 clients, including friends and family members, for policies that he never purchased.
Rosenbaum, the owner of a suburban Chicago insurance agency has been sentenced to seven years in federal prison for swindling more than $1 million from clients by collecting annuity premiums for policies that he never purchased, the U.S. Attorney’s Office, Northern District of Illinois announced last week.
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
Ignore Court Orders at Your Peril
Frivolous Litigation and Frivolous Appeal Causes Default to Be Entered
PROOF OF FRAUDULENT CLAIM REQUIRED SUIT
Plaintiff-Appellee Transamerica Life Insurance Company (“Transamerica”) sued Defendants-Appellants Akop Arutyunyan and his daughter Anahit Arutyunyan for allegedly engaging in a conspiracy to defraud Transamerica into paying benefits under a long-term care insurance policy.
In Transamerica Life Insurance Company v. Akop Arutyunyan; Anahit Arutyunyan, No. 22-55199, United States Court of Appeals, Ninth Circuit (February 22, 2024) Transamerica sued to avoid paying benefits to a fraudulent disability claim.
You can read the full article and all of this issue of ZIFL at http://zalma.com/.../uploads/2024/02/ZIFL-03-01-2024.pdf
(c) 2024 Barry Zalma & ClaimSchool, Inc.
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Please tell your friends and colleagues about this blog and the videos and let them subscribe to the blog and the videos.
Subscribe to my substack at https://lnkd.in/gRxm92Kr
Go to X @bzalma; Newsbreak.com https://lnkd.in/g8azKc34; Barry Zalma videos at Rumble.com at https://lnkd.in/gV9QJYH; Go to Barry Zalma on YouTube- https://lnkd.in/g2hGv88; Go to the Insurance Claims Library – https://lnkd.in/gwEYk.
The Largest Residential Burglary of All Time
Post 5407
Fraud & the Fear of Bad Faith Suits
Posted on July 22, 2026 by Barry Zalma
See the full video at https://lnkd.in/gWQQEySW and at https://lnkd.in/gyhdK6wv
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection 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.
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection 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.
After ...
Chutzpah is not Enough
Post 5397
Posted on July 20, 2026 by Barry Zalma
See the video and at https://lnkd.in/gNUs2XzT and at https://lnkd.in/g2MawyzX
Magistrate Issues a Search Warrant if there is a Fair Probability that Contraband or Evidence of a Crime will be Found in a Particular Place.
In United States Of America v. Frank Suess, et al., CRIMINAL No. 3:24-308, United States District Court, M.D. Pennsylvania (July 16, 2026) a federal grand jury indicted Frank Suess, Melissa Driscoll, and others in a 55-count health care fraud and anti-kickback prosecution arising from an alleged scheme involving medically unnecessary prescription “foot baths.”
As part of the investigation, the FBI obtained an August 19, 2022 warrant to search Driscoll’s Sterling Pharmacy Yahoo email account for emails from January 1, 2018 through December 31, 2020. Driscoll moved to suppress the resulting evidence, arguing that the warrant lacked probable cause, was overbroad, and rested on material misstatements and omissions.
LAW:
The ...
Fraud Shouldn’t Pay
Post 5396
See the video and at https://rumble.com/v7ctgmq-the-great-jewel-theft.html at https://youtu.be/aRbQ2sJfGwA
This is a Fictionalized True Crime Story of Insurance Fraud explaining why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is one of a collection 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.
The Insured purchased, for the first time in his life, a policy of Personal Articles Floater Insurance (PAF) scheduling $125,000 worth of ladies jewelry. He advised the insurer that the jewelry was always kept in a class E safe at his residence. He also told the insurer that he was employed full time as the owner of a gasoline service station and that he had never been canceled or suffered a previous loss.
One month after the policy was ...
Day Care Owner Loses Subsidies Because She Criticized State
Post 5421
Posted on August 11, 2026 by Barry Zalma
First Amendment Right Will be Allowed to Go to Trial
In Betsey J. Grant v. Maine State Department Of Heath And Human Services, No. 1:25-cv-00490-JAW, United States District Court, D. Maine (August 6, 2026), Betsey J. Grant, a licensed childcare provider and operator of Tiny Tikes Daycare in Trenton, Maine, sued Maine DHHS and several employees after she publicly criticized DHHS before Maine’s Government Oversight Committee and alleged that officials retaliated against her.
She claimed DHHS imposed and extended a conditional license, published stigmatizing information, interfered with subsidies and program funding, removed her from a food program, rescinded an expansion grant, and used biased or falsified evidence in licensing proceedings. Following the March 10, 2023, GOC testimony, Ms. Grant alleges that foster children's subsidies (approximately $30,000) were withheld; she was removed from the ...
Rescission for Material Misrepresentation
Post 5418
Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units. After an underlying personal injury action was filed, Union Mutual determined that the property actually contained three apartment units and rescinded the policies on the ground that the defendants had made a material misrepresentation in the applications.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true ...
Rescission for Material Misrepresentation
Post 5418
Posted on August 5, 2026 by Barry Zalma
An Insurer May Rescind An Insurance Policy Where The Applicant Made A Material Misrepresentation In The Application.
In Union Mutual Fire Insurance Company v. 844 Knickerbocker, LLC, et al. No. 2024-10359, Index No. 602824/22, 2026 NY Slip Op 04789, Supreme Court of New York, Second Department (July 29, 2026) Union Mutual Fire Insurance Company issued commercial insurance policies to 844 Knickerbocker, LLC, and Sanjaya Mallick based on applications stating that the insured property contained two apartment units.
LAW:
A misrepresentation is material if the insurer would not have issued the same policy, or would have issued it only on different terms, had the true facts been disclosed. To establish materiality as a matter of law, the insurer must submit documentation of its underwriting practices, such as manuals, guidelines, bulletins, or rules addressing similar risks.
DISCUSSION/ANALYSIS:
As a result, the...
