Zalma’s Insurance Fraud Letter Volume 29, Issue 5
The Source for the Insurance Fraud Professional
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Read the full issue of Zalma's Insurance Fraud Letter for March 1, 2025 at https://lnkd.in/g9h3xuGn and https://lnkd.in/gGyuDaze, see the full video at https://lnkd.in/g6dJW9G5 and at https://lnkd.in/gtbchYPG, and at https://zalma.com/blog plus more than 5000 posts.
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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/ You can read the full issue of the March 1, 2025 issue at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
This issue contains the following articles about insurance fraud:
Auto Fraud Schemes
The Swoop and Squat
The swoop and squat auto insurance fraud is a deliberate attempt by a driver to claim auto insurance payouts by setting up an accident on the roads. These accidents usually involve an unsuspecting victim rear-ending the criminal, with at least an accomplice helping him.
In a swoop and squat auto insurance fraud, at least two people are involved. These two conspirators will scout the streets with their vehicles for their preferred target. Usually, a high value auto or a commercial vehicle will, more likely than not, be insured.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
California Department of Insurance Issues Warning About Tow Truck Scams
The California Department of Insurance issued a PSA with a warning for California drivers about an increase in scams involving tow truck companies targeting car accident victims where vehicles are being held hostage for cash. The scam has become prevalent in SoCal. See the video at https://x.com/i/status/1892004401218245112
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
Heath Insurance Fraud Convictions
Man Convicted, Sentenced After Trial For Submitting False MassHealth Claims For Autism Behavioral Health Treatment
After Five-Day Trial, Defendant Found Guilty of Stealing More Than $33,000 in MassHealth Funds
Donald Martel, age 69, of Georgetown, was convicted after a five-day trial for fraudulently billing MassHealth, the state’s Medicaid program, for applied behavioral analysis (ABA) services that were never provided. Martel was sentenced to three years’ probation and ordered to pay full restitution, stay away from and have no contact with witnesses, and refrain from all work, billing, and responsibilities with MassHealth members.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
MORE MCCLENNY MOSELEY & ASSOCIATES ISSUES
This is ZIFL’s forty-second 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.
In MMA Law Firm, PLLC, formerly known as McClenny, Moseley & Associates, PLLC v. PCG Claims, LLC d/b/a PCG Consulting, LLC, No. 01-24-00217-CV, Court of Appeals of Texas, First District, Houston (December 31, 2024), A Law Firm filed a Suggestion of Bankruptcy informing this Court that appellant filed a petition for Chapter 11 bankruptcy in Case Number 24-31596 in the United States Bankruptcy Court for the Southern District of Texas.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
COMPACT BOOK OF ADJUSTING PROPERTY CLAIMS FOURTH EDITION
In Kindle, paperback and hardback formats, The Compact Book of Adjusting Property Claims, Fourth Edition is now available for purchase here and here. The Fourth Edition contains updates and clarifications from the first three editions plus additional material for the working adjuster and the insurance coverage lawyer.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
CONVICTIONS OF OTHER THAN HEALTH INSURANCE FRAUD
Two Washington State Residents Guilty of Insurance Fraud
Jason Weisfeld of Federal Way, Washington, and Fedaa Shakir, pleaded guilty to submitting false insurance claims. A carpet-cleaning claim and a fake theft of a Hyundai has led to guilty pleas for the two people for insurance fraud in Washington.
Weisfeld filed a false insurance claim relating to a carpet cleaning incident that resulted in an investigation by the Washington State Insurance Commissioners’ Investigations Unit.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
Deterring Insurance Fraud
A New Book on Insurance Fraud and How the DOJ Deters and Defeats Insurance Fraud.
INSURANCE FRAUD IS EPIDEMIC
Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. No one knows the amount that is taken by insurance fraud because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $308 billion to more than $500 billion every year. The only certainty is that it is a serious crime that bleeds the insurance industry sufficiently to have states compel insurers to create special investigative units (SIU’s) to investigate, deter and defeat insurance fraud to assist the state in its efforts to prosecute the crime.
The book is now available as a Kindle book, a paperback and hardcover at amazon.com
RED FLAGS OF FRAUD
Suspicious claims have common attributes. Insurers and their anti-fraud organizations have collated the common attributes into lists of indicators or red flags of fraud. The lists were created as training aids and to be used to determine whether further investigation is required to determine if a claim is legitimate or false and fraudulent.
Continually growing, these lists are known as the “red flags” or “indicators” of fraud lists. There are many different categories, ranging from those associated with the claim itself or with insureds to indicators of specific types of fraud, such as bodily injury fraud or arson for profit.
Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
BARRY ZALMA
Barry Zalma, Inc., 4441 Sepulveda Boulevard, CULVER CITY CA 90230-4847, 310-390-4455. Subscribe to Excellence in Claims Handling at https://barryzalma.substack.com/welcome. Write to Mr. Zalma at [email protected]; https://www.zalma.com; https://zalma.com/blog.
He publishes daily articles at https://zalma.substack.com, Go to the Insurance Claims Library – https://zalma.com/blog/insurance-claims-library/ to consider more than 50 volumes written by Barry Zalma on insurance and insurance claims handling.
Read the full article and the full 18 page ZIFL at https://zalma.com/blog/wp-content/uploads/2025/02/ZIFL-02-15-2025.pdf
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Read the full article and the full issue of ZIFL at https://zalma.com/blog/wp-content/uploads/2025/03/ZIFL-03-01-2025.pdf
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
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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 ...
Inadequately Briefed Issues Defeats Appeal
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Issues on Appeal Must be Adequately Briefed
Posted on September 25, 2026 by Barry Zalma
In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.
According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair. The defendant denied negligence and alleged comparative negligence. After a two-day jury trial in November 2023, the jury returned a defense verdict.
The trial court denied Ojekwe’s motion to set aside the verdict and for a new trial, and he appealed.
LAW
A trial court’s refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of ...
Inadequately Briefed Issues Defeats Appeal
Post 4852
Issues on Appeal Must be Adequately Briefed
Posted on September 25, 2026 by Barry Zalma
In Emy Ojekwe v. Connecticut Transit District Consortium, No. AC 47389, Court of Appeals of Connecticut (September 22, 2026) Emy Ojekwe alleged that he was injured on September 24, 2020, while leaving a bus operated by Connecticut Transit District Consortium, doing business as Greater Bridgeport Transit Authority.
According to his complaint, the wheelchair ramp began to rise before he had fully exited, causing his wheelchair to fall backward and allegedly injuring several parts of his body and damaging the wheelchair.
LAW
Refusal to set aside a verdict because of counsel’s improper remarks is reviewed for abuse of discretion.
Appellate claims receiving only cursory treatment, without record citations, supporting authority, or legal analysis, are inadequately briefed.
DISCUSSION
Improper opening remarks.
Defense counsel referred to Ojekwe’s national origin,...
Psychiatrist Who Was Convicted of Fraud Asked the First Circuit to Reduce his Punishment
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Posted on September 24, 2026 by Barry Zalma
Fraud to Private and Public Health Insurers Doesn’t Pay
In United States v. Gustavo Kinrys, Nos. 24-1592, 24-1716, United States Court of Appeals, First Circuit (September 21, 2026) Gustavo Kinrys, a Massachusetts psychiatrist, submitted fraudulent claims to private and public health insurers from 2015 through 2018, including bills for more than 1,000 sessions when he or the purported patient was outside the country. When insurers requested supporting records, he delayed through a fictitious office manager and created false documentation.
A jury convicted Kinrys on fourteen counts. The district court imposed a 99-month sentence, calculated intended loss at slightly more than $19 million based on billed amounts, ordered $6,537,309.59 in restitution, and ordered $6,527,391.19 in forfeiture.
At sentencing, the district court calculated Kinrys’s base offense level to be ...
